Cardiovascular effects of cigarette smoking compared to transdermal nicotine

Abstract

Smoking is a major cause of premature death and disability worldwide. Despite intensive efforts by health professionals and the public health community, 15% of Brazilians continue to smoke, and these rates are even higher in other parts of the world. The best way to reduce the harmful effects of smoking is clear, stop smoking. However, for many smokers who can not quit smoking, there has been much recent discussion in the medical community about ways to reduce the harmful effects of smoking (harm reduction). Three main strategies have been proposed to reduce the harm caused by tobacco use. 1 tobacco change in order to reduce toxic substances. 2 similar products to develop cigarettes that expose individuals to less combustion products than cigarettes (Ex. Electronic cigarettes). 3 Use of pharmaceuticals, such as nicotine medications to suppress the consumption of cigarettes and thereby reduce exposure to combustion products and other toxic substances in tobacco. One of the key issues in the evaluation of products with different levels of nicotine or nicotine use to suppress the consumption of cigarettes, is the safety of nicotine per se. Concerns about the safety of nicotine have been related mainly to cardiovascular disease and reproductive problems. The focus of this proposal is the cardiovascular safety of nicotine. The mechanisms by which smoking causes cardiovascular disease have not been fully established, but many potential mechanisms have been identified. These include stroke, relative hypoxemia, endothelial dysfunction, increased angiogenesis, lipid abnormalities, hemodynamic stress, coronary vasoconstriction, pro-inflammation, increased adherence of neutrophils and monocytes to endothelial cells, hyperhomocysteinaemia, insulin resistance, and induction of arrhythmogenesis (through the release of catecholamines). The aim of this study is to compare the effects of smoking with nicotine transdermal adhesives in two doses and placebo on potential biomarkers of cardiovascular disease. Such biomarkers would include hemodynamic effects, pro-coagulant effects, endothelial function, inflammation, insulin sensitivity and lipid effects. (AU)