Improvement of endothelial glycocalyx thickness is associated improvement of arterial elasticiy in STEMI patients after smoking cessation

Abstract Background Smoking constitutes a modifiable risk factor in St Elevation Myocardial Infarction (STEMI) patients. Those who quit smoking reduce their risk for future disease and mortality by 1/3 at 2 years. Purpose The aim of this study is to investigate whether STEMI smokers who cease smoking after their index event differ in arterial stiffness, endothelial integrity compared to STEMI smokers who continue smoking. Methods We included STEMI patients from the Cardiology Department of a university hospital who had been hospitalized for STEMI. We applied Propensity score matching for age, sex and cardiovascular risk factors (prevalence of diabetes, hypertension, smoking and hyperlipidemia). We totally enrolled 60 STEMI smokers, out of which a) n=30 quitted smoking after their discharge and b) n=30 continued smoking. We measured at recruitment (after their discharge) and at 4-month follow-up: a) perfused boundary region (PBR) of the sublingual microvessels with a lumen diameter ranging from 4 to 25 μm, as a marker of endothelial glycocalyx integrity and b) carotid-femoral pulse wave velocity (PWV - Complior SP ALAM) and central systolic blood pressure (cSBP), as a marker of arterial stiffness. Results We included participants aged 59±8 years, 42/60 (70%) were males. The baseline values of PWV, cSBP and PBR did not differ between the two groups (p0.05 for all comparisons). At 4-month follow-up, smoking quitters showed an important reduction of PBR 4-25 (2.03 ± 0.2 vs. 2.20 ± 0.28 μm), PBR 4-9 (1.52 ± 0.11 vs. 1.68 ± 0.16 μm), PBR 10-19 (2.10 ± 0.24 vs. 2.34 ± 0.21 μm), PBR 20-25 (2.49 ± 0.41 vs. 2.70 ± 0.44 μm) and PWV (9.8 ± 2.1 vs. 10.9 ± 2.3 m/s) (p 0.05 for all comparisons). No significant changes in the aforementioned markers were observed in participants who continued smoking (p 0.05; Table). Also, cSBP remained steady in quitters (121.2 ± 8 vs 119.5 ± 7, p0.05) whereas deteriorated in active smokers (130.1 ± 9 vs 118.8 ± 8, p=0.039). In patients who ceased smoking, the percentage reduction of PBR 4-25 was associated with the corresponding decrease of PWV (r = 0.39, p = 0.042) at 4 months. Conclusion Smoking cessation following STEMI results in amelioration of arterial stiffness and thickness of endothelial glycocalyx at 4-month follow-up.