234 Early improvement in peripheral vascular tone following smoking cessation using nicotine replacement therapy: aortic wave reflection analysis

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Cigarette smoking induces cardiovascular pathology and worsens arterial stiffness. Arterial stiffness can be assessed non-invasively on 2 indices: pulse-wave velocity (PWV), indicating aortic stiffness, and augmentation index (AIx), indicating aortic wave reflection. The impact of smoking cessation (SC) nicotine replacement therapies (NRT) on arterial stiffness remains unknown. AIx and PWV were studied prospectively (SphygmoCor) in 26 long-term smokers (>10 cigarettes/day; mean age, 43 ± 6 yrs) before (V1) and 28 and 56 days (V2, V3) after SC supported by NRT. Two-way repeated-measures ANOVA was used with patients serving their own controls on intention-to-treat analysis. Abstinence was ascertained when exhaled carbon monoxide (CO) was <10ppm; the quantity of NRT absorbed was assessed from the serum cotinine level. 16/24 patients (67%) were abstinent at end of study; 8/24 had cut down on smoking; 2 were lost to follow-up. CO and serum cotinine levels fell after SC. Mean AIx for the population as a whole was 23.4% at V1, with significant early reduction by V2 (16.2%) and V3 (13.9%) (ANOVA p<0.001). PWV, peripheral blood pressure and heart rate were unchanged. Multivariate analysis failed to identify predictive factors among baseline characteristics, cigarette addiction levels, or evolution of expired CO or serum cotinine. The improvement in AIx and stability of PWV after SC with NRT indicate improved peripheral vascular tone. This impact may account for the early clinical benefit of SC observed even when associated to NRT.