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DOI: 10.1055/s-0038-1650214
The Effect of Cigarette-Smoking on Cardiovascular Risk Factors: a Study of Monozygotic Twins Discordant for Smoking
Publication History
Received 21 December 1994
Accepted after resubmission 20 September 1995
Publication Date:
10 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199601/lookinside/thumbnails/10-1055-s-0038-1650214-1.jpg)
Summary
The association of cigarette smoking with the development of occlusive vascular disease is firmly established. Unfavourable changes in a series of variables held independent risk factors for the development of vascular lesions (HDL-cholesterol, haematocrit, white blood cell count, fibrinogen and plasminogen activator inhibitor-1 (PAI-1)) are thought to be directly influenced by cigarette smoking. However, the role played by the genotype in the effect of smoking on the above parameters has not been investigated. To control the genotype, we studied the relationship between cigarette smoking and a series of cardiovascular risk factors in 27 monozygotic twin pairs (7 male and 20 female pairs, mean age ± SD: 47.4 ± 12.9 yrs) with a life-long discordance for smoking. Smoking twins had a life-long dose of smoking (Brickman index) of 287.3 ± 241.5. Body mass index, blood pressure, haematocrit, haemoglobin and red blood cell counts, total cholesterol levels and the acute phase reactants α-acid glycoprotein and C-reactive protein were similar in smokers and non-smokers. Triglyceride was higher by 12.6% (9.5-35%, 95% confidence interval, p = 0.02) and HDL-cholesterol lower by 7.5% (0.2-15%, p = 0.04) in the smoking co-twins, who also had 8.4 % (-0.2-17%, p = 0.06) higher white blood cell counts and 4.1% (1.2-7%, p <0.01) larger mean platelet volume. There was no significant difference in clottable fibrinogen (by two methods) or in the activity of plasminogen activator inhibitor-1 between the two groups, nor was the within-pair difference in these parameters related to the smoking dose. Echo-doppler examination of the carotid arteries of 24 twin pairs showed mostly minor atherosclerotic lesions in 46% and 42% of the smoking and non-smoking co-twins. After adjustment for age, systolic blood pressure and platelet count and volume were the only variables significantly associated to the presence of vascular lesions. Cigarette smoking is associated with an atherogenic lipid profile and with changes in platelets and white cells potentially reflecting endothelial cell damage. When controlling the genotype, fibrinogen and PAI-1 activity levels did not seem directly influenced by cigarette smoking.
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References
- 1 Kannel WB, McGie DC, Castelli WP. Latest perspectives on cigarette smoking and cardiovascular disease. The Framingham study. J Cardiac Rehabil 1984; 4: 267-277
- 2 Doll R, Peto R. Mortality in relation to smoking: 20-year observations on male British doctors. BMJ 1976; 2: 1525-1536
- 3 McGill HC. The cardiovascular pathology of smoking. Am Heart J 1988; 1: 250-255
- 4 Martin JF, Bath PMV, Burr ML. Influence of platelet size on outcome after myocardial infarction. Lancet 1991; 338: 1409-1411
- 5 Kazuomi K, Takefumi M, Kazukiyo N. Cigarette smoking increases the mean platelet volume in the elderly patients with risk factors for atherosclerosis. Clin Lab Haemat 1992; 14: 281-287
- 6 Stone MC, Thorp JM. Plasma fibrinogen - a major coronary risk factor. J Royal Coll Gen Pract 1985; 35: 565-569
- 7 Meade TW, Brozovic M, Chakrabarti RR, Haines AP, Imesin JD, Mellons S. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1986; 2: 533-537
- 8 Hamsten A, Walldins G, Szamosi A, Blombäck M, De Faire U, Dahleu G, Landon C, Wiman B. Plasminogen activator inhibition in plasma: risk factor for recurrent myocardial infarction. Lancet 1987; 2: 3-9
- 9 Meade JK, Imeson J, Stirling Y. Effects of changes in smoking and other characteristics on clotting factors and the risk of ischaemic heart disease. Lancet 1987; 1: 986-988
- 10 ECAT angina pectoris study: baseline associations of haemostatic factors with extent of coronary arteriosclerosis and other coronary risk factors in 3000 patients with angina factors undergoing coronary angiography. Eur Heart J 1993; 14: 08-17
- 11 Haire WD, Goldsmith JC, Rasmussen J. Abnormal fibrinolysis in healthy male cigarette smokers: role of plasminogen activator inhibitors. Am J Hematol 1989; 31: 36-40
- 12 Lee AT, Smith WCS, Lowe GDO, Tunstall-Pedoe H. Plasma fibrinogen and coronary risk factors: the Scottish Heart Health Study. J Clin Epidemiol 1990; 9: 913-919
- 13 Thomas AE, Green FR, Kelleher CM, Wilkes HC, Brennan PS, Meade TW, Humphries SE. Variation in the promoter region of the β fibrinogen gene is associated with plasma fibrinogen levels in smokers and non-smokers. Thromb Haemost 1991; 65: 487-490
- 14 Hamsten A, De Faire U, Iselius L, Blombäck M. Genetic and cultural inheritance of plasma fibrinogen concentration. Lancet 1987; 1: 988-990
- 15 Liljefors I. Coronary heart disease in male twins. Hereditary and environmental factors in concordant and discordant pairs. Acta Med Scand (suppl) 1970; 511: 01-90
- 16 Cederlof R, Friberg L, Ludman T. The interactions of smoking, environment and heredity and their implications for disease etiology. A report of epidemiological studies on the Scottish twin registries. Acta Med Scand (suppl) 1977; 612: 001-128
- 17 Haapanen A, Koskenvno M, Kaprio S, Kesaniemi YA, Heikkila K. Carotid arteriosclerosis in identical twins discordant for cigarette smoking. Circulation 1989; 80: 10-16
- 18 King MC, Friedman GD, Lattanzio D, Rodgers G, Lewis AM, Dyry ME, Williams H. Diagnosis of twin zygosity by self-assessment and by genetic analysis. Acta Genet Med Gemellol 1980; 29: 121-126
- 19 Brickman GL, Catats EO. The prevalence of chronic bronchitis in an industrial population. Am Rev Resp Dis 1962; 86: 47-54
- 20 Friedewald WT, Levi R, Fredrickson DS. Estimation of serum low density lipoprotein without the use of a preparative ultracentrifuge. Clin Chem 1972; 18: 499-502
- 21 Strong JP, Richards ML. Cigarette smoking and atherosclerosis in autop-sied men. Atherosclerosis 1976; 23: 451-458
- 22 Averbach O, Garfinkel L. Atherosclerosis and aneurism of the aorta in relation to smoking habits and age. Chest 1980; 78: 805-807
- 23 Salonen J, Puska P, Tuomiletho J, Homan K. Relation of blood pressure, serum lipids and smoking to the risk of cerebral stroke: a longitudinal study in Eastern Finland. Stroke 1982; 13: 327-333
- 24 Holme I, Enger SC, Helgeland A, Kjermann Z, Leren P, Lund-Larsen PG, Solberg LA, Strong JP. Risk factors and raised atherosclerotic lesions in coronary and cerebral arteries. Statistical analysis from the Oslo Study. Atherosclerosis 1981; 1: 250-256
- 25 Sternly NIM. Atherosclerosis, smoking and other risk factors. In: International Symposium on Atherosclerosis, 5th, Houston, Texas, November 6-9, 1979 Gotto Jr AM, Smith LC, Allen B. eds Proceedings, Atherosclerosis U; New York: Springer: 1980: 67-70
- 26 Carmelli D, Swan GE, Robinette D, Fabsitz R. Genetic influence on smoking: a study of male twins. N Engl J Med 1992; 327: 829-833
- 27 Austin AM, King MC, Bawol RD, Hulley SB, Friedman GD. Risk factors for coronary heart disease in adult female twins. Genetic heritability and shared environmental influences. Am J Epidemiol 1987; 125: 308-318
- 28 Cohn BA. Behavioral factors and HDL cholesterol in female twins: a multivariate analysis. PhD dissertation University of California; Berkeley: 1984
- 29 Friedman GD, Klatsky AL, Siegelaub AB. The leukocyte count as a predictor of myocardial infarction. New Engl J Med 1974; 290: 1275-1278
- 30 Prentice RL, Szatrowski TP, Kato H, Plason MW. Leukocyte counts and cerebrovascular disease. J Chronic Dis 1982; 35: 703-714
- 31 Pittilo RM, Clarke JMF, Harris D, Mackie IJ, Rowels PM, Machin SJ, Woolf N. Cigarette smoking and platelet adhesion. Br J Haematol 1984; 58: 627-632
- 32 Lassila R, Seyberth HW, Haapanen A, Schweer H, Koskenvuo M, Laustio-la KE. Vasoactive and atherogenic effects of cigarette smoking: a study of monozygotic twins discordant for smoking. BMJ 1988; 297: 955-957
- 33 Humphries SE, Cook M, Dubowitz M, Stirling Y, Meade TW. Role of genetic variation at the fibrinogen locus in determination of plasma fibrinogen concentrations. Lancet 1987; i: 1452-1455
- 34 Kannel WB, Wolf PA, Castelli W, D’Agostino B. Fibrinogen and risk of cardiovascular disease. The Framingham Study. JAMA 1987; 258: 1183-1186
- 35 Balleisen L, Bailey J, Epping P-H, Schulte H, van de Loo J. Epidemiological study on factor VII, factor VIII and fibrinogen in an industrial population: I. Baseline data on the relation to age, gender, body weight, smoking, alcohol, pill using and menopause. Thromb Haemost 1985; 54: 475-479
- 36 Hamsten A, Blomback M, Wiman B, Svensson J, Szamosi A, de Faire U, Mettinger L. Haemostatic function in myocardial infarction. Br Heart J 1986; 55: 58-66
- 37 Cortellaro M, Boschetti C, Cofrancesco E, Zanussi C, Catalano M, De Gaetano G, Gabrielli L, Lambardi B, Specchia G, Tarassi L, Tremoli E, Della Volpe A, Polli E. and the PLAT Study Group The PLAT Study: a multidisciplinary study of hemostatic function and conventional risk factors in vascular disease patients. Atherosclerosis 1991; 90: 109-118
- 38 Wu KK, Folsom AR, Heiss G, Davis CE, Coulan MG. Barnes R for the ARIC Study Investigators. Association of coagulation factors and inhibitors with carotid artery atherosclerosis. Early results of the atherosclerosis risk in communities (ARIC) study. Ann Epidemiol 1992; 2: 471-480
- 39 Ernst E, Resch KL. Fibrinogen as a cardiovascular risk factor: A meta analysis and review of the literature. Ann Intern Med 1993; 118: 956-963
- 40 Haverkate F, Thompson SG, Duckert F. Interrelationship between haemostasis factors in angina pectoris patients and relation to gender, age, drug use and acute phase reaction. Results from the ECAT Angina Pectoris Study Group. Thromb Haemost 1995; 73: 561-567
- 41 Gram J, Declerk PJ, Sidelmann J, Jespersen J, Kluft C. Multicentre evaluation of commercial kit methods: Plasminogen Activator Inhibitor Activity. Thromb Haemost 1993; 70: 852-857