Comparative characteristics of metabolism and inflammation indicators, structural and functional condition of the cardiovascular system and tolerance to physical exercise in young people depending on the method of nicotine delivery

Authors:

Barsukov Anton Vladimirovich—Grand PhD in Medical Sciences (Dr. Med. Sci.), Professor, Associate Professor of Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; Deputy Chief Physician of KardioKlinika, 25 Kuznetsovskaya Street, 196105 St. Petersburg, Russian Federation; e-mail: avbarsukov@ yandex.ru; https://orcid.org/0000-0002-1943-9545.

Dydyshko Vladislav Tadeevich — PhD in Medical Sciences (Cand. Med. Sci.), lecturer, Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vlad-didishko@mail.ru; https://orcid.org/0000-0002-0244-8672.

Glebova Svetlana Anatolievna — PhD in Medical Sciences (Cand. Med. Sci.), supervisor of the training center of KardioKlinika, 25 Kuznetsovskaya Street, 196105 St. Petersburg, Russian Federation; e-mail: glebova-sa@ kardioklinika.ru; https://orcid.org/0000-0003-1627- 587X.

Sergeev Alexander Sergeevich – 4th year cadet, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: sergeevaleksandr@internet.ru; https://orcid.org/0009-0001-4392-2502.

Vorotnikova Anastasia Viktorovna – clinical resident of the Department of Internal Medicine, Nephrology, General and Clinical Pharmacology with a course in Pharmacy, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevsky Ave, 195067 St. Petersburg, Russian Federation; e-mail: nnvorot@yandex.ru.

Borisova Ekaterina Viktorovna — Grand PhD in Medical Sciences (Dr. Med. Sci.), Chief Physician of KardioKlinika, 25 Kuznetsovskaya Street, 196105 St. Petersburg, Russian Federation; Professor, Department of Internal Medicine, Nephrology, General and Clinical Pharmacology with a course in Pharmacy, North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevsky Ave, 195067 St. Petersburg, Russian Federation; e-mail: borisova-ev@kardioklinika.ru; https://orcid.org/0000-0002-0960-9627.

Annotation:

Introduction. Health assessment in young people who smoke regularly seems relevant given the known risks of early onset of cardiovascular, bronchopulmonary, oncological diseases, and development of metabolic syndrome. The gradual shift from the widespread use of traditional cigarettes to the active use of alternative nicotine delivery systems in the modern young population determines the need for scientific research aimed at objectifying their impact on metabolic indices, systemic low-intensity non-infectious inflammation, the state of the cardiovascular system and other functional systems of the body.

Aim. To study the indicators of the main types of metabolism, proinflammatory pattern, structural and functional state of the cardiovascular system, physical endurance in somatically healthy young people depending on the method of method of nicotine delivery – smoking cigarettes or using alternative nicotine delivery sources (ANDS).

Materials and methods. We analyzed 411 archival case histories of men aged 35-44 years without clinically significant somatic pathology. The cohort of men (n=411) was divided into three age- and body mass index (BMI)-matched groups depending on their smoking status. Group 1 included 275 (age 40.94±4.90 years) non-smoking subjects. Group 2 consisted of 68 (age 41.09±3.85 years) male smokers of traditional cigarettes. Group 3 included 68 (mean age 39.82±6.31 years) male users of alternative nicotine delivery systems (ANDS). The data of office blood pressure (BP) and heart rate (HR), biochemical blood analysis, standard electrocardiography (ECG), echocardiography, 24-hour ECG and BP monitoring, and bicycle ergometry (BEM) to assess physical endurance were studied. In an additionally selected (based on a retrospective study of outpatient records) cohort of somatically healthy young individuals (n=93; 62 men and 31 women), divided into two groups depending on method of nicotine delivery and matched by age and BMI (30 regular smokers of traditional cigarettes (TC) or ANDS (without separation by type of tobacco product), 63 non-smokers; age 36.41±8.94 and 37.29±6.49 years, respectively), a comparative analysis of lipid metabolism parameters was performed. Individuals included in both cohorts did not take any medications. For statistical processing of the data, the Statistica for Windows software package (version 13) was used, using the nonparametric statistics module (Mann-Whitney U test).

Results. Among the examined men of the main cohort (n=411), office systolic BP (SBP) was significantly higher in men of the traditional smoking and ANDS groups compared to that in non-smoking men (p=0.02, p=0.04, respectively). Office HR in TC smokers significantly exceeded that in non-smokers (p=0.004) and insignificantly – in ANDS users (p>0.05). The levels of high-density lipoprotein cholesterol (HDL-C) were the lowest, and triglycerides (TG) – the highest in TC smokers, differing significantly from those in non-smokers (p=0.004 and p=0.02, respectively). In TC smokers, the level of HDL-C was lower (p>0.05), and the level of TG – higher (p>0.05) than in ANDS users. The level of C-reactive protein was lower in ANDS users than in TC smokers (p=0.003) and lower than in non-smokers (p=0.038). The thickness of the interventricular septum (IVS) and the left ventricle posterior wall (LV PW) in diastole was significantly less in non-smoking men compared to TC smokers (p=0.007, p=0.006, respectively). The thickness of the IVS was lower in ANDS users than in TC smokers and greater than in non-smoking men (p=0.10 and p=0.62, respectively). Non-smokers had a significantly lower relative wall thickness (RWT) of the LV compared to TC smokers (p=0.002) and ANDS users (p=0.03). Non-smoking men had significantly lower average daily, average daytime, average nighttime HR than TC smokers (p=0.046, p=0.05, p=0.006, respectively) and ANDS users (p=0.024, p=0.046, p=0.022, respectively). TC smokers were characterized by the lowest exercise tolerance (ET), assessed by the number of metabolic units accumulated during the BEM test (in relation to non-smokers and ANDS users: p=0.042; p>0.05, respectively). Statistical analysis of data in an additional sample (n=93) showed that smokers (without differentiation by gender and nicotine delivery systems) had significantly lower HDL-C levels than non-smoking subjects (p=0.02).

Discussion. The medical and social significance of the problem under consideration is obvious, since, together with known risk factors, smoking in various forms can adversely affect the cardiovascular and general prognosis, indicating the need to rethink the problem and the possibility of lifestyle modification.

Summary. Young men who are TC smokers are characterized by a worse profile of office HR, SBP, overnight HR values, lipid metabolism, proinflammatory pattern, greater LV concentricity, and the lowest physical tolerance compared to non-smoking men and ANDS users. Among the lipid metabolism indicators, the HDL-C level is the most deviated (reduced) from the norm in young smokers. Analysis of cardiovascular risk biomarkers, such as HDL-C, TG, C-reactive protein, and fibrinogen, revealed positive dynamics in ANDS users compared to TC, indicating a decrease in risk. The harm reduction concept, realized by “switching” from TC smoking to using ANDS, may improve cardiovascular prognosis. Further short-term and long-term studies of ANDS are needed to assess their impact on smoker’s health compared with TC smoking and to explore the possibility of incorporating the results of these studies into recommendations for the prevention and treatment of tobacco-related diseases. This knowledge is critical for the development of public health strategies and clinical guidelines for harm reduction and smoking cessation.

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