1. Effect of cigarette smoking on myocardial workload in young adults
DR. SUNIL KUMAR JENA
Senior Resident
VIMSAR

2. Background
Cigarette smoking is an established risk factor of coronary artery disease.
Different researchers reported that cigarette smoking affects myocardial workload. Very few studies evaluate the effect of very low intensity of smoking on heart.
Thus I proposed this study to evaluate the effect of very low intensity of smoking on myocardial workload in young adults.

3. AIM & OBJECTIVE 1
To assess smoking status of young adults 2
To observe the effect of cigarette smoking on HR, SBP and RPP 3
To quantify the association between cigarette smoking and risk of heart disease

4. Material and Method Study Place – Department of Physiology ,VIMSAR
Study Period –
Jan 2016 – Dec 2016
Type of study – Comparative
Subjects – (MBBS Students)
1.Case 60
(smoker)
2.Control 48
(nonsmoker)

5. Material and method
Case (n=60) - Apparently healthy male medical students,
current smokers, minimum 1 year H/O smoking
Control (n=48) - Apparently healthy male medical students,
never smoke any cigarette or consume any nicotine product
Exclusion criteria –
Occasional smokers, Cardiovascular disease, Endocrinal disorder,
Renal disease, Neural disease, F/H of DM
Information sheet
Name-
Age-
Are you a smoker ? – yes/no
Duration of smoking-
No of cigarettes smoke per day
H/O any systemic disease
F/H of disease -

6. Material and method
PY = No of Cigarettes smoke per day × No of years of smoking / 20 (Bernaards CM et al. Addiction 2001;96: )
Measurement of HR – Carotid pulsation
Avg HR=
BP – Sphygmomanometry
HR and BP was recorded after 10 min of rest
RPP = HR × SBP×10-2 (White WB. Am J Hypertens 1999;12:S50-5)
HR1+HR2+HR3 3

7. Statistical analysis
SPSS 16
Unpaired
T test
P< 0.05
Odd’s Ratio

8. result Variables Minimum Maximum Mean±SD Duration of smoking in year 113
3.6±2.94
No of cigarettes smoke per day 2 12
3.8±2.1
Pack Year
0.1
3.3
0.679±0.670

9. RESULT Variables Case (n=60) (Mean±SD) Control (n=48) p HR 84±9.1
75±8.7
<0.0001
SBP
133±10.5
117±7.5

10. result Variable Case (n=60) (Mean±SD) Control (n=48) p RPP 113.9±1.94
88.6±1.19
<

11. Result Variables Risk of Heart Disease (RPP>100)
No Risk of Heart Disease
(RPP≤100)
Odd’s Ratio p
Case (n=60) 44 16
19.25
<
Control (n=48) 6 42

12. DISCUSSION
To avoid gender and age variation of different hemodynamic variables subjects were selected from single gender i.e. male and within a narrow range of age group i.e. between 19 to 24 years.
Increase in HR, SBP and RPP in smoker than nonsmoker may be due to sympathovagal imbalance.

13. Decrease Cardiac vagal tone
DISCUSSION
Neuropeptide Y
Decrease Cardiac vagal tone
Nicotine
Impaired baroreceptor sensitivity
Increase sympathetic discharge

14. DISCUSSION HR, SBP and RPP are valuable markers of MVO2.
There is linear relationship between these markers and MVO2. Increase in MVO2 signifies increase in myocardial workload.
This study suggested that in smokers MVO2 is high, hence very low intensity smoking increases myocardial workload.

15. LIMITATIONS Mismatch of BMI of the subjects.
Did not exclude the sleep habit and stress level of students.
HR was calculated by carotid pulsation, not by ECG.

16. CONCLUSION
Summarizing this study it is concluded that very low intensity of cigarette smoking also increases myocardial workload, hence risk of heart disease.

17. MESSAGE TO SOCIETY
Prevention is better than cure. Therefore young adults should be counseled and motivated to avoid cigarette smoking for fit and healthy life.

18. ACKNOWLEDGEMENT
I am very much thankful to Dr. Palas Kumar Majhisamanta, intern VIMSAR for substantial contribution towards this study. Also thankful to subjects, without whom accomplishment of this study was not possible.

19. REFERENCES
Jonas MA, Oates JA, Ockene JK, Hennekens CH. Statement on smoking and cardiovascular disease for health care professionals. American Heart Association. Circulation 1992;86:
Bernaards CM, Twisk JW, Snel J, Van Mechelen W, Kemper HC. Is calculating pack-years retrospectively a valid method to estimate life-time tobacco smoking? A comparison between prospectively calculated pack-years and retrospectively calculated pack-years. Addiction 2001;96:
White WB. Heart rate and the rate-pressure product as determinants of cardiovascular risk in patients with hypertension. Am J Hypertens 1999;12:S50-5.
Sarnoff SJ, Braunwald E. Hemodynamic determinants of oxygen consumption of the heart with special reference to the tension-time index. Am J Physiol1958; 192: 148–156).
Adamopoulos D, van de Borne P, Argacha JF. New insights into the sympathetic, endothelial and coronary eff ects of nicotine. Clin Exp Pharmacol Physiol 2008;35: