Just One Cigarette Has Harmful Effect On Arteries Of Young Healthy Adults

Even one cigarette has serious adverse effects on young adults, according to research presented by Dr. Stella Daskalopoulou at the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.Her study found that smoking one cigarette increases the stiffness of the arteries in 18 to 30 year olds by a whopping 25 per cent.

Arteries that are stiff or rigid increase resistance in the blood vessels, making the heart work harder. The stiffer the artery, the greater the risk for heart disease or stroke.

"Young adults aged 20-24 years have the highest smoking rate of all age groups in Canada," says Dr. Daskalopoulou, an internal medicine and vascular medicine specialist at McGill University Health Centre. "Our results are significant because they suggest that smoking just a few cigarettes a day impacts the health of the arteries. This was revealed very clearly when these young people were placed under physical stress, such as exercise."

The study compared the arterial stiffness of young smokers (five to six cigarettes a day) to non-smokers. The median age was 21 years. Arterial measurements were taken in the radial artery (in the wrist), the carotid artery (in the neck), and in the femoral artery (in the groin), at rest and after exercise.

Arterial stiffness in both smokers and non-smokers was measured using a new but well established method called applanation tonometry. Dr. Daskalopoulou introduced the 'arterial stress test' which measures the arteries' response to the stress of exercise. The test is comparable to a cardiac stress test, which measures the heart's response to the stress of exercise.

"In effect we were measuring the elasticity of arteries under challenge from tobacco," explains Dr. Daskalopoulou.

An initial arterial stress test was carried out to establish a baseline measurement for both the non-smokers and the smokers, who were asked not to smoke for 12 hours prior to the test. After the first meeting, smokers returned and smoked one cigarette each and then repeated the stress test. During the final meeting, smokers were asked to chew a piece of nicotine gum prior to the stress test.

Dr. Daskalopoulou found that after exercise the arterial stiffness levels in non-smokers dropped by 3.6 per cent. Smokers, however, showed the reverse: after exercise their arterial stiffness increased by 2.2 per cent. After nicotine gum, it increased by 12.6 per cent. After one cigarette, it increased by 24.5 per cent.

Interestingly, there was no difference in the arterial stiffness measurements between smokers and non-smokers at rest.

"In effect, this means that even light smoking in otherwise young healthy people can damage the arteries, compromising the ability of their bodies to cope with physical stress, such as climbing a set of stairs or running to catch a bus," says Dr. Daskalopoulou. "It seems that this compromise to respond to physical stress occurs first, before the damage of the arteries becomes evident at rest."

"More than 47,000 Canadians will die prematurely each year due to tobacco use, which often starts in the teen years," warns Heart and Stroke Foundation spokesperson Dr. Beth Abramson. "We know that over 90 per cent of teenagers who smoke as few as three to four cigarettes a day may be trapped into a lifelong habit of regular smoking, which typically lasts 35 to 40 years."

Smoking contributes to the build up of plaque in the arteries, increases the risk of blood clots, reduces the oxygen in the blood, increases blood pressure, and makes the heart work harder. Smoking also nearly doubles the risk of ischemic stroke.

Dr. Abramson says this study reinforces the importance of education, prevention programs, and legislation such as the recently passed Bill C-32, Cracking Down on Tobacco Marketing Aimed at Youth Act.

Thyroid Surgery Safe For Older Patients, Study Finds

Thyroid surgery is safe for older patients, say physicians who found only slight differences in rates of complications and hospital readmissions in a multi-year study."We were pleasantly surprised," says Dr. Melanie W. Seybt, endocrine-head and neck surgeon at the Medical College of Georgia and first author of the study, published in the journal Archives of Otolaryngology -- Head and Neck Surgery. "We suspected older patients might be admitted to the hospital more often, have more complications and more cancer."

But their study of 428 thyroidectomy patients at MCGHealth Medical Center and the Charlie Norwood Veterans Affairs Medical Center between November 2003 and December 2007, including 44 patients over age 65 and 86 between ages 21-35, showed few differences in the two groups.

Surgeons found:

* They could do outpatient surgery in both groups at essentially the same rate, 45.5 percent in the elderly and 51.2 percent in younger patients
* Similar complication rates, with 12.5 percent of older patients having transient problems with low calcium versus 11.1 percent of younger patients.
* The thyroid growth was suspected to be malignant in 4.5 percent of elderly patients and 2.3 percent of younger patients. Final pathology revealed cancer in 27.3 percent of elderly patients and 18.6 percent of older patients.
* Elderly patients had a slightly higher hospital readmission rate -- 4.5 percent versus 1.2 percent -- but readmissions were related to the transient problems with calcium levels not age-related complications.
* Neither group had post-operative bleeding or permanent vocal cord paralysis.

She hopes the findings will decrease concerns among patients and practitioners about the safety of thyroidectomies in the growing elderly population, noting that thorough preoperative screening, important at any age, likely helped minimize adverse reactions in their older patients.

Although thyroid disease tends to be most common in young women, the number of older patients diagnosed with the problem is escalating, Dr. Seybt says, noting that the oldest patient in this study group was 84. With a geriatric population that has increased by 90 percent in the last 30 years, according to the U.S. Census Bureau, the numbers are likely to continue upward.

"A lot of our older patients have other problems, such as heart failure, hypertension and restrictive lung disease, so we are very aggressive about getting medical clearance and optimizing control of their other problems," Dr. Seybt says.

She notes that head and neck surgeries generally have less complications and quicker recoveries than procedures in other parts of the body, such as the abdomen or chest. Low calcium levels are a common complication of thyroid surgery because the adjacent parathyroid glands are typically a little stunned by removal of the thyroid gland, she says. To help avoid problems, patients are routinely placed on a three-week tapering dose of calcium but sometimes still have transient problems, most commonly numbness or tingling around the lips and cramping of the hands and feet. Because of the close proximity to the vocal cords, patients also can have transient or permanent hoarseness.

While its exact cause is unknown, thyroid disease tends to run in families and radiation exposure is believed to be a risk factor for thyroid cancer. The increased availability of quality, non-invasive screening such as ultrasound likely means more cases are being identified at every age, Dr. Seybt says.

Laptop-sized ultrasounds are showing up in many physician offices and thyroid nodules also show up when patients have more sophisticated studies of the head and neck, such as an MRI scan, for other reasons. Patients or their doctors often just feel nodules in the neck although they can be oddly asymptomatic until they grow large enough to impact swallowing and/or breathing. While some of these larger growths are very obvious, those that grow downward into the chest or toward the back can be harder to detect. In older patients, many of the growths likely have been there a while, Dr. Seybt says.

Depending on the size of the growth in patients, surgeons at MCG and the VA will use one of three different approaches. These include a standard, several-inch incision at the base of the neck for the largest growth as well as include minimally invasive thyroidectomy, in which surgeons work through an incision about half the size of the norm, and an endoscopic approach, in which video monitoring and a thin, ultrasonic scalpel reduce incision size another half.

Dr. David Terris, chair of the Department of Otolaryngology-Head and Neck Surgery in the MCG School of Medicine and a pioneer of the minimally invasive approaches, showed in the March 2006 issue of Laryngoscope that the newer, minimally invasive approaches, which reduce the incision size and recovery time, could be used safely in most patients. Dr. Terris is corresponding author on the current study.

Dr. Terris and Sunny Khichi, a senior medical student at MCG, are study co-authors.