The role of smoking in the development of heart disease: endothelial dysfunction

Smoking is a proven risk factor for heart and vascular disease. Many studies confirm the destructive effect of tobacco smoke on the walls of blood vessels.

• Tobacco smoke has a direct damaging effect on the cells lining the inner wall of the vessels – endotheliocytes.
• Endothelium-dependent vasodilating (vasodilator) effect decreases.
• Proliferation (reproduction) of smooth muscle fibers of vascular walls increases.

These changes are called endothelial dysfunction; this condition is “fertile ground” for the development of heart and vascular diseases.

Smoking and Ischemic Heart Disease

Coronary heart disease is the main cause of deaths of young people (men and women) who have a bad habit. Smoking contributes to the development of this disease, causing the following changes in the heart and blood vessels:

The most sensitive to the harmful components of tobacco smoke is the microcirculatory bed – a complex of small-caliber vessels that provide nourishment to the tissues. After smoking a cigarette in young people, a narrowing of venules and arterioles is observed, which is accompanied by a decrease in blood flow to the organ and the development of ischemia. At the same time, the heart muscle receives less oxygen than it normally needs.

• After smoking, there is a slowdown in blood flow and the formation of a “sludge-phenomenon” – gluing of red blood cells, which increases the risk of thrombosis.
• Tobacco smoking reduces anti-atherosclerotic protection, making the vessels defenseless.

The main process in the development of coronary heart disease is atherosclerosis, today the disease is considered as a “lifestyle disease”, where smoking is considered one of the main risk factors for its development.
Coronary heart disease develops faster if risk factors “overlap” —for example, smoking is associated with diabetes mellitus or hypertension, obesity, etc.

Atherosclerotic heart disease in smokers

Smokers develop atherosclerosis 1.5-6 times more often than non-smokers. Tobacco smoking, along with arterial hypertension and dyslipoproteinemia, increases the risk of atherosclerosis. Studies of blood vessels in smokers, whose death did not come from a cardiovascular pathology, but for some other reason, also shows that they have more pronounced atherosclerosis of vessels than non-smokers.

Nicotine and tobacco smoke damage the inner lining of the blood vessels – endothelium. And atherosclerotic processes develop faster on the damaged endothelium.

The components of cigarette smoke can affect metabolic processes, in particular, cause dyslipidemia, which plays an important role in atherogenesis.
The severity of the disease is directly dependent on the number of cigarettes smoked per day:

• When smoking more than a dozen cigarettes a day, patients have a more common vascular lesion – more vessels are involved in the process than in atherosclerotic heart disease in non-smokers. Atherosclerotic aortic aneurysm in smokers develops 8 times more often.
• Clinically, the disease occurs with more frequent attacks of angina – angina pain occurs daily, several times.

Tabacco and myocardial infarction

Myocardial infarction, as an acute form of coronary artery disease, is now significantly “younger”. If earlier it was believed that necrosis of the heart muscle develops in individuals after 40 years, today it is recorded in 20-year-olds. And smoking in the development of this disease plays an important role:

• After smoking a cigarette, the number of heartbeats increases;
• Blood pressure rises;
• The need of the heart muscle for oxygen increases;
• Smoking contributes to the development of coronary artery spasm. Attacks of ischemia in smokers develop 3 times more often;
• Cigarette smoke can affect blood clotting, increasing its viscosity, reducing anticoagulant functions, leading to blood clots.

Especially hard, and often fatal, myocardial infarction occurs in young people. This is due to the fact that bypassing the circulatory system has not yet had time to develop, the site of necrosis captures a large area of ​​myocardium.

Devidence of smoking and the state of the cardiovascular system

With respect to smoking, there is no established safe “dose”. Even when smoking a small number of cigarettes a day (two-three cigarettes), the risk of developing coronary heart disease doubles, and the life expectancy is reduced by about one year.

Quitting smoking reduces the risk of sudden cardiac death — after a year it is reduced by 50%. And after 10 years, it does not differ from that of a person who has never smoked.

Positively, getting rid of a bad habit also affects the state of the vascular wall – the risk of atherosclerosis in “former smokers” decreases and has no differences from that of non-smokers after just a year of quitting tobacco.
Patients who have suffered a myocardial infarction, especially recommended to give up the bad habit. Indeed, even against the background of treatment, the risk of recurrent myocardium in smokers remains very high.

Picture Credit: aamiraimer

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Parting happens not only in romantic relationships, but also between friends. The reasons can be different. But if the friendship is no longer in joy and does not work to preserve it, it is better to stop the relationship, or to remain good friends. How can we determine that friendship has worsened? And what signs can indicate an unreliable and superficial friendly relationship, which should be abandoned?

1. Frequent secrets from a friend
The best news (new love, promotion, successes of the child, etc.), many people prefer to share with their friends. But if recently there is a desire to keep most of the significant events secret from a friend, then most likely the friendship has deteriorated noticeably. The reason for this is often jealousy or jealousy from a friend who demonstrates them more and more. Such feelings can be determined by words, behavior, facial expressions and emotions of a person. Good friends know how to sincerely rejoice at each other’s successes. If frank communication with a friend becomes a burden, then such a relationship is unlikely to succeed.

2. Psychological pressure
Constant condemnation and criticism of the actions of a friend is a sure sign of an urgent problem in the relationship. Friendship is called upon to unite, support and preserve mutual respect. If a person more often began to hear negative statements about himself from a friend, it is important to find out the relationship and learn the true reasons for this behavior of the friend. Regular condemnation and the imposition of one’s own opinion worsen friendship.

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3. Egoism in communication
Any relationship is built on communication, and friendship including. If only one person solves in the conversation of friends, then it is hardly possible to talk about a real friendly conversation. At the heart of a normal dialogue is the communication of two people, and not the monologue of one of the interlocutors. A distinctive feature of a good friend is the ability to listen. Egocentrists, often talking only about themselves, are bad comrades who do not want to waste time.

4. Bad influence
When a person notices that his friend is increasingly pushing him to commit bad deeds, it is worth thinking about whether his friendship is so good and sincere? For example, one friend may provoke another to start smoking, drinking alcohol, changing his wife, etc. A true friend will not expose his companion to situations that threaten health, well-being or life. The provocateur often pursues selfish goals, wishing to substitute the named friend, and most to remain innocent. From such dangerous people you need to stay away, and it’s better to completely stop communicating with them.

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5. Unreliable friendship
You can always rely on a good friend in any business. If a friend starts to let his friend often (he is late for a meeting, forgets about general plans, duty, promises, etc.), then it is difficult to build a normal and long-term relationship with him. A person who truly respects and values ​​his friend, tries to be preventive, consistent, compulsory and always restrains his promises given to a friend. If such a condition for friendship is often violated, then you should not continue it.

6. Unilateral interests
To maintain any relationship, a person sometimes has to partially sacrifice one’s own interests for the benefit of his partner or friend. This is a normal and justified approach. Friendship should be bilateral and mutual. It is impossible to take into account the interests of only one party. Of course, it is also necessary to make concessions, but if you do them more and more often without a reaction from them on the part of a friend, then this friendship can not be called real. A friend should not constantly impose on his comrade only his own desires, thinking only of himself. Such attitudes negatively affect self-esteem and personal development.

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7. Excessive obsession
When a friend constantly requires attention, unceremoniously imposing his society, it is hardly possible to maintain strong friendship with him. This behavior of a person is for various reasons. First, this may be the self-doubt that provokes the development of jealousy and fear, when it always seems that a friend will start to be friends with someone else. Secondly, excessive egoism and a sense of superiority come to the forefront. In this case, a person begins to think that his friend should give him attention at first request. In any case, friendship with a too intrusive person quickly becomes a burden.

8. Negative attitude to everything
It is very difficult to be friends with grumblers and pessimists, who constantly do not like something or do not like it. They often whine, grumble, complain and get angry. After communicating with them, there is an unpleasant, heavy sediment, negative emotions and a bad mood. It’s unlikely that such people are good as friends. After all, friendship should bring joy and pleasure from communication. With its help, a person can get rid of stress, be charged with positive energy and optimism. Why torture yourself and spoil your mood by talking with a pessimist and whiner? Better stay away from him.

9. Emotional discomfort

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When a person begins to notice obvious psychological discomfort in the presence of his friend, it is important to find out the true cause of such a phenomenon. Usually friends with pleasure communicate with each other and look forward to meeting. If it is unpleasant to be alone with a friend, then most likely the relationship with him has undergone strong changes. Sometimes, with a timely explanation of the cause of the severance of relations can be avoided, since real friends will always try to understand each other and find a compromise. If this can not be done, then the friendship that brings discomfort and unpleasant emotions is better to be completed.

10. Constant lie
This is a dangerous enemy of any relationship. It’s one thing when a friend does not hold back promises, is late or forgets about duty, and quite another when he begins to openly tell lies to his comrade. Even worse, if such a lie is fraught with unpleasant consequences for a person. If a friend is more and more often lying, and besides doing it intentionally, then maintaining a relationship with him does not make sense.

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