Effects of smoking regular or light cigarettes on brachial artery flow-mediated dilation


      Background and purpose

      To compare the effects of regular cigarettes (RCs) and light cigarettes (LCs) on brachial artery flow-mediated dilation (FMD) and sublingual glyceryl trinitrate-induced dilation (GTN), markers of endothelial dependant and independent function, respectively.


      206 subjects (age 51.5 ± 12.8 yr, 122 men) had their smoking habits recorded and FMD and GTN measured by B-mode ultrasound. Cigarettes were categorized as RCs or LCs according to their content of tar, nicotine and CO. The chronic effect was assessed in current smokers of RCs (n = 85) or LCs (n = 53) and in never smokers (NS; n = 68). The acute effect was assessed in current smokers by measuring FMD before and 10-min after smoking a single regular (n = 29) or light (n = 51) cigarette.


      FMD was significantly lower in consumers of RCs (6.26%, 95% C.I. 5.58, 6.94) or LCs (5.59%, 95% C.I. 4.74, 6.45) compared to NS (8.68%, 95% C.I. 7.92, 9.44) (both P < 0.0001), but did not differ (P > 0.05) when compared to each other. GTN was similar in the three groups. Analyses adjusted for clinical confounders and for markers involved in oxidative stress, arginine/nitric oxide pathway, and inflammation provided identical results. Smoking a single cigarette, either regular or light, reduced FMD (−0.88% and −1.17%, respectively, both P < 0.05), without significant difference between cigarette type. RCs and LCs produced analogous chronic and acute effects when FMD was calculated with respect to the last 60 s of the low-flow phase (FMD60s).


      LCs impair endothelial-dependant vasodilation as much as RCs. Thus, smoking LCs cannot be considered an alternative to the only safe choice of a complete and permanent smoking cessation.


      • The study compared the effect of light and regular cigarettes on endothelial function.
      • The effect of chronic smoking on endothelial function is independent of the type of cigarette smoked.
      • Even the lowest dose of cigarettes has a maximal detrimental effect on FMD.
      • A single cigarette, both regular or light alike, impairs FMD even in chronic smokers.
      • The so-called “light” cigarettes impair endothelial function as much as regular cigarettes.


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        • Shiffman S.
        • Pillitteri J.L.
        • Burton S.L.
        • Rohay J.M.
        • Gitchell J.G.
        Smokers' beliefs about "Light" and "Ultra Light" cigarettes.
        Tob Control. 2001; 10: i17-i23
        • Borland R.
        • Yong H.H.
        • King B.
        • et al.
        Use of and beliefs about light cigarettes in four countries: findings from the International Tobacco Control Policy Evaluation Survey.
        Nicotine Tob Res. 2004; 6: S311-S321
        • Kozlowski L.T.
        • Goldberg M.E.
        • Yost B.A.
        • et al.
        Smokers' misperceptions of light and ultra-light cigarettes may keep them smoking.
        Am J Prev Med. 1998; 15: 9-16
        • Baldassarre D.
        • Castelnuovo S.
        • Frigerio B.
        • et al.
        Effects of timing and extent of smoking, type of cigarettes, and concomitant risk factors on the association between smoking and subclinical atherosclerosis.
        Stroke. 2009; 40: 1991-1998
        • Shechter M.
        • Issachar A.
        • Marai I.
        • et al.
        Long-term association of brachial artery flow-mediated vasodilation and cardiovascular events in middle-aged subjects with no apparent heart disease.
        Int J Cardiol. 2009; 134: 52-58
        • Etsuda H.
        • Takase B.
        • Uehata A.
        • et al.
        Morning attenuation of endothelium-dependent, flow-mediated dilation in healthy young men: possible connection to morning peak of cardiac events?.
        Clin Cardiol. 1999; 22: 417-421
        • Corretti M.C.
        • Anderson T.J.
        • Benjamin E.J.
        • et al.
        Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force.
        J Am Coll Cardiol. 2002; 39: 257-265
        • Sonka M.
        • Liang W.
        • Lauer R.M.
        Automated analysis of brachial ultrasound image sequences: early detection of cardiovascular disease via surrogates of endothelial function.
        IEEE Trans Med Imaging. 2002; 21: 1271-1279
        • Stadler R.W.
        • Ibrahim S.F.
        • Lees R.S.
        Measurement of the time course of peripheral vasoactivity: results in cigarette smokers.
        Atherosclerosis. 1998; 138: 197-205
        • Gori T.
        • Dragoni S.
        • Lisi M.
        • et al.
        Conduit artery constriction mediated by low flow a novel noninvasive method for the assessment of vascular function.
        J Am Coll Cardiol. 2008; 51: 1953-1958
        • Sorensen K.E.
        • Celermajer D.S.
        • Spiegelhalter D.J.
        • et al.
        Non-invasive measurement of human endothelium dependent arterial responses: accuracy and reproducibility.
        Br Heart J. 1995; 74: 247-253
        • Ghiadoni L.
        • Faita F.
        • Salvetti M.
        • et al.
        Assessment of flow-mediated dilation reproducibility: a nationwide multicenter study.
        J Hypertens. 2012; 30: 1399-1405
        • Gullu H.
        • Caliskan M.
        • Ciftci O.
        • et al.
        Light cigarette smoking impairs coronary microvascular functions as severely as smoking regular cigarettes.
        Heart. 2007; 93: 1274-1277
        • Gallus S.
        • Randi G.
        • Negri E.
        • Tavani A.
        • La Vecchia C.
        Tar yield and risk of acute myocardial infarction: pooled analysis from three case-control studies.
        Eur J Cardiovasc Prev Rehabil. 2007; 14: 299-303
        • Parish S.
        • Collins R.
        • Peto R.
        • et al.
        Cigarette smoking, tar yields, and non-fatal myocardial infarction: 14,000 cases and 32,000 controls in the United Kingdom. The International Studies of Infarct Survival (ISIS) Collaborators.
        BMJ. 1995; 311: 471-477
        • Woodward M.
        Is compulsory restriction of tar yield of cigarettes a worthwhile public health policy?.
        Am J Prev Med. 2001; 21: 284-290
        • Oh D.L.
        • Heck J.E.
        • Dresler C.
        • et al.
        Determinants of smoking initiation among women in five European countries: a cross-sectional survey.
        BMC Public Health. 2010; 10: 74
        • Barone-Adesi F.
        • Vizzini L.
        • Merletti F.
        • Richiardi L.
        Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction.
        Eur Heart J. 2006; 27: 2468-2472
        • Hammond D.
        • Fong G.T.
        • Cummings K.M.
        • Hyland A.
        Smoking topography, brand switching, and nicotine delivery: results from an in vivo study.
        Cancer Epidemiol Biomarkers Prev. 2005; 14: 1370-1375
        • Hecht S.S.
        • Murphy S.E.
        • Carmella S.G.
        • et al.
        Similar uptake of lung carcinogens by smokers of regular, light, and ultralight cigarettes.
        Cancer Epidemiol Biomarkers Prev. 2005; 14: 693-698
        • Jarvis M.J.
        • Boreham R.
        • Primatesta P.
        • Feyerabend C.
        • Bryant A.
        Nicotine yield from machine-smoked cigarettes and nicotine intakes in smokers: evidence from a representative population survey.
        J Natl Cancer Inst. 2001; 93: 134-138
        • Barua R.S.
        • Ambrose J.A.
        • Eales-Reynolds L.J.
        • et al.
        Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: an in vivo and in vitro correlation.
        J Am Coll Cardiol. 2002; 39: 1758-1763
        • Poredos P.
        • Orehek M.
        • Tratnik E.
        Smoking is associated with dose-related increase of intima-media thickness and endothelial dysfunction.
        Angiology. 1999; 50: 201-208
        • Tanriverdi H.
        • Evrengul H.
        • Kuru O.
        • et al.
        Cigarette smoking induced oxidative stress may impair endothelial function and coronary blood flow in angiographically normal coronary arteries.
        Circ J. 2006; 70: 593-599
        • Esen A.M.
        • Barutcu I.
        • Acar M.
        • et al.
        Effect of smoking on endothelial function and wall thickness of brachial artery.
        Circ J. 2004; 68: 1123-1126
        • Karatzi K.
        • Papamichael C.
        • Karatzis E.
        • et al.
        Acute smoke-induced endothelial dysfunction is more prolonged in smokers than in non-smokers.
        Int J Cardiol. 2007; 120: 404-406
        • Neunteufl T.
        • Heher S.
        • Kostner K.
        • et al.
        Contribution of nicotine to acute endothelial dysfunction in long-term smokers.
        J Am Coll Cardiol. 2002; 39: 251-256
        • Ciftci O.
        • Caliskan M.
        • Gullu H.
        • et al.
        Acute effects of smoking light cigarettes on coronary microvascular functions.
        Clin Cardiol. 2009; 32: 210-214