TOBACCO - AN ATHEROGENIC, THROMBOGENIC OR SPASMOGENIC FACTOR

Smoking is one of the major causes of morbidity and mortality in the d eveloped world. The main cause of death related to smoking is myocardi al infarction. Smoking not only accelerates the process of atheroscler osis but also predisposes to acute complications, early in atheromatou s disease, and which may be fatal. Complex effects implicated in cardi ac complications include hypercoagulability, increased cardiac work, r educed oxygen transport and delivery catecholamine liberation, and cor onary vasoconstriction. These effects of tobacco which increase myocar dial oxygen consumption whilst decreasing oxygen delivery, participate in precipitating acute cardiovascular complications. They are mainly related to the actions of nicotine and carbon monoxide. The atherogeni city of smoking seems to be related to the many adverse effects on end othelial function, vascular tone, haemostasis, lipid profile and infla mmatory cells. The action of oxidising and toxic glycation products, w hich are present in cigarette smoke and active on the vascular wall, a re the principal mediators.