Chapter 9 Cardiovascular Disease

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Cardiovascular Disease: Stroke

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Smoking increases the risk for carotid artery disease and transient ischemic attacks,

or "warning" strokes.

Cigarettes, p. 103

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Smoking increases the risk for both the hemorrhagic and occlusive/ischemic type of

stroke.

Cigarettes, p. 103

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"Cigarette smoking accelerates atherosclerosis and promotes acute ischemic events.

The mechanisms of effects of smoking are not fully elucidated but are believed to

include (1) hemodynamic stress: nicotine increases heart rate and transiently

increases blood pressure; (2) endothelial injury; (3) development of an atherogenic

lipid profile: smokers have on average higher LDL, more oxidized LDL, and lower

HDL cholesterol than nonsmokers; (4) enhanced coagulability; (5) arrhythmogenesis;

and (6) relative hypoxemia due to effects of carbon monoxide. Carbon monoxide

reduces the capacity of hemoglobin to carry oxygen and impairs the release of oxygen

from hemoglobin to body tissues, resulting in a state of relative hypoxemia. To

compensate for this hypoxemic state, smokers develop polycythemia, with

hematocrits often 50% or more. The polycythemia also increases blood viscosity,

which adds to the risk of thrombotic events."

Cecil Textbook of Medicine, 1996 edition, p. 34

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In a study from Australia, the risk for ischemic stroke was twice as high for

nonsmokers whose spouses smoked as for those whose spouses did not smoke.

American Journal of Public Health, April 1999, p. 572

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Thursday, July 06, 2000

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