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Atherosclerosis. 2011 Apr;215(2):500-6. doi: 10.1016/j.atherosclerosis.2011.01.012. Epub 2011 Jan 21.

Effects of smoking on coronary microcirculatory function: a twin study.

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  • 1Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA 30322, USA.



In asymptomatic smokers, coronary microcirculatory dysfunction, assessed by coronary flow reserve (CFR), is an early indicator of cardiovascular risk. Inflammation and oxidative stress may be the mechanisms through which smoking affects the microvasculature.


The purpose of this study was to determine the relationship between smoking and CFR, taking into account potential shared genetic effects.


We examined 360 male middle aged twins (288 non-smokers and 72 smokers), including 46 twin pairs discordant for current smoking. Coronary flow reserve (CFR) in response to adenosine was measured with positron emission tomography [N(13)] ammonia and quantitation of coronary blood flow at rest and after adenosine stress. Inflammation was assessed by measuring interleukin-6 and C-reactive protein, and oxidative stress was determined by measuring plasma hydroperoxides, glutathione (GSH), the oxidized form of GSH, GSSG, and the ratio of GSH to GSSG.


CFR was significantly lower in smokers compared to nonsmokers (2.25 vs. 2.75, p<0.01). This relationship persisted after accounting for known cardiovascular disease risk factors, and was marginally affected by adjusting for inflammatory and oxidative stress biomarkers. In addition, in smoking-discordant twin pairs, CFR in the smoking twin was significantly lower than in the non-smoking co-twin (2.25 vs. 2.67, p=0.03) even after adjustment for cardiovascular risk factors.


Our results demonstrate the adverse effects of smoking in the early phases of cardiovascular disease. Mechanisms other than peripherally measured inflammation and oxidative stress are involved.

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