Adverse Effects of Cigarette and Noncigarette Smoke Exposure on the Autonomic Nervous System: Mechanisms and Implications for Cardiovascular Risk

• Published in: Journal of the American College of Cardiology Vol. 64; no. 16; pp. 1740 - 1750
• Main Authors: MIDDLEKAUFF, Holly R, PARK, Jeanie, MOHEIMANI, Roya S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 21-10-2014
• Subjects: Animals; Atherosclerosis (general aspects, experimental research); Autonomic Nervous System - drug effects; Autonomic Nervous System - physiology; Baroreflex - drug effects; Baroreflex - physiology; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Heart; Humans; Medical sciences; Menstrual Cycle - drug effects; Menstrual Cycle - physiology; Particulate Matter - adverse effects; Risk Factors; Smoke - adverse effects; Smoking - adverse effects; Smoking - epidemiology; Toxicity; Cardiovascular disease; Exposure; Mechanism; Vascular disease; Cigarette; Tobacco; Autonomic nervous system; Atherosclerosis; Risk factor; Cardiovascular risk; Secondary effect; Circulatory system; Cardiology; blood pressure; heart rate; autonomic nervous system; inflammation; afferent neurons; reactive oxygen species; oxidative stress
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2014.06.1201

This review summarizes the detrimental effects of cigarette and noncigarette emission exposure on autonomic function, with particular emphasis on the mechanisms of acute and chronic modulation of the sympathetic nervous system. We propose that the nicotine and fine particulate matter in tobacco smoke lead to increased sympathetic nerve activity, which becomes persistent via a positive feedback loop between sympathetic nerve activity and reactive oxidative species. Furthermore, we propose that baroreflex suppression of sympathetic activation is attenuated in habitual smokers; that is, the baroreflex plays a permissive role, allowing sympathoexcitation to occur without restraint in the setting of increased pressor response. This model is also applicable to other nontobacco cigarette emission exposures (e.g., marijuana, waterpipes [hookahs], electronic cigarettes, and even air pollution). Fortunately, emerging data suggest that baroreflex sensitivity and autonomic function may be restored after smoking cessation, providing further evidence in support of the health benefits of smoking cessation.