Smoking habit and changes of endothelial glycocalyx and arterial stiffness in AMI patients after one year follow up

Background

Smoking cessation constitutes a fundamental secondary prevention intervention after ST elevation Myocardial Infarction (STEMI).

Purpose

We investigated at 12 months after STEMI the association between smoking status with mood disorder and their interrelation with arterial stiffness and integrity of endothelial glycocalyx.

Methods

We included smokers hospitalized for STEMI. We also included a matched group (for age, sex, hypertension, diabetes, hyperlipidemia) of STEMI non-smokers as a control group. All smokers had attended the smoking cessation clinic after their discharge for their index event. We evaluated at baseline, at 6 and at 12 months: a) smoking status and nicotine dependence via Fagerström Test, b) levels of depressive symptoms via Zung Self-Rating Depression Scale, c) arterial stiffness via carotid-to-femoral pulse wave velocity (PWV), central systolic blood pressure (cSBP) and d) thickness of endothelial glycocalyx through measurement of perfused boundary region of the sublingual microvessels with diameter range 4-25 μm.

Results

We totally included 190 STEMI patients, aged 59±8 years, 133/190 (70%) were males, of which 150 were active smokers and 40 non-smokers (control group). At 6-month follow-up, 91/150 (60,6%) smokers had quitted smoking and managed to abstain from smoking at 12-month follow-up. Out of 91 quitters, 70 (77%) quitted smoking on their own , 10 (11%) received Nicotine replacement therapy and 11 (12%) cytisinicline. Fageström score was reduced significantly during follow-up assessments (from 4.68±1.13 to 1.75±0.36 to 1.26±0.23 respectively, p<0.05), whereas Zung score remained unchanged (p>0.05). Baseline Fageström score was associated with baseline Zung score (r=0.218, p=0.036) and this association was not overt at follow-up.

During 12-month follow-up, smoking AMI quitters and non smokers displayed a significant decrease of PBR4-25, PWV, cSBP compared to AMI patients who continued smoking (for PBR4-25: -5.65% and -6.57% vs -0.95% respectively, p<0.05;for PWV: -18.39% and -13.74% vs -3.41% respectively, p<0.05; for cSBP: -9.30% and -7.25% vs 11.92%, p<0.05).

Among those who continued smoking those who further increasedFagerström score at 1 year showed greater increase of PWV (r=0.364, p=0.04)

Conclusions

One year after the after the index event, STEMI smokers who quit smoking one showed a similar amelioration of arterial stiffness and integrity of endothelial glycocalyx to non smoker AMI patients while those who continued smoking showed no improvement in vascular functionTable