VASCULAR ABNORMALITIES ASSOCIATED WITH LONG-TERM CIGARETTE-SMOKING IDENTIFIED BY ARTERIAL WAVE-FORM ANALYSIS

PURPOSE: Consistent changes in the arterial pulse contour are found wi th aging and disease states that impair the compliance characteristics of blood vessels that buffer pulsatile phenomena in the arterial tree . We assessed whether vascular adaptation in structure or tone of bloo d vessels associated with long-term cigarette smoking would influence steady state or pulsatile hemodynamics at a preclinical stage. PATIENT S AND METHODS: We analyzed intraarterial brachial artery waveforms in 35 healthy long-term cigarette smokers and 32 nonsmoking control subje cts matched for age and gender. The diastolic pressure decay was segme nted into two components: an exponential decay that reflects the compl iance characteristics of the large arteries and an oscillatory diastol ic waveform generated principally by pulsewave reflections from small arteries and arterioles. RESULTS: Resting heart rate was higher in smo kers than nonsmokers, mean +/- SD (66 +/- 9 versus 60 +/- 10; P <0.05) . Systolic, diastolic, and mean arterial pressures were lower in smoke rs compared with nonsmokers (P <0.01 for all). No differences in cardi ac output, large artery compliance, or systemic vascular resistance es timates where apparent between groups. A decrease in the amplitude and duration of the diastolic wave, produced by peripheral pulsewave refl ections in the arterial system, was found in smokers compared with non smokers'(0.04 +/- 0.02 versus 0.7 +/- 0.03; P <0.001). CONCLUSIONS: Qu antitative changes in the arterial waveform were found in long-term sm okers compared with nonsmoking control subjects. The altered arterial waveshape marks the presence of abnormal structure or tone in the peri pheral vasculature that affects pulsatile arterial function. This meas ure of vascular injury is detectable at a preclinical stage and may re late to the subsequent risk of morbid events in chronic smokers and ai d in clinical risk stratification. (C) 1997 by Excerpta Medica, Inc.