oa Editorial [Hot topic: Modifying Cardiovascular Risk Factors: Epidemiology and Characteristics of Smoking-Related Cardiovascular Diseases (Executive Editor: Aurelio Leone)]

Smoking appears to be always the most harmful risk factor for heart and blood vessels being targeted by some of the organs tobacco components [1-3]. Of these, primarily nicotine and its metabolites and carbon monoxide, the latter is not a product of tobacco fresh leaf but develops from lit cigarette, are strongly associated with the damage of cardiovascular system. Generally, the reviews on tobacco smoke indicate the damage caused by cigarettes and lacking the systematic findings on the harm caused by pipe or cigar smoking that are common industrial products of tobacco [4]. In addition, a question that needs some clarifying concepts is: what is the definition of tobacco smoke and what is the socio-cultural dimension of the association of smoking with cardiovascular risk? The review of Leone et al. [5] discusses the subject. The common definition of smoking as the inhalation of the smoke of burned tobacco that may occur occasionally or habitually as a consequence of a physical addiction to some chemicals, primarily nicotine, cannot be fully accepted today since several clinical, biological, metabolic, epidemiologic, statistic and socio-economic factors that play a basic role in determining individual damage due to smoking are missing in this assessment. The analysis of findings shows undoubtedly that several constituents of cigarette smoking play a strong role in the development and progression of cardiovascular damage, primarily atherosclerotic lesions. Nicotine and its metabolites, carbon monoxide and also thiocyanate seem to be the most specific markers of damage that, in the time, becomes irreversible. Cigarette smoking is addictive because of nicotine and nicotine withdrawal causes many side effects of quitting smoking and usually increases cardiovascular risk. Therefore, what is smoking? Smoking must be defined as a chemical toxicosis which is able to cause detrimental effects either of acute or chronic type on different structures of the body like cardiovascular system, respiratory system and epithelial glands target organs. In addition, smoking causes physical addiction, primarily due to nicotine, that adversely influences smoking cessation. From these observations there is evidence that a large number of socio-economic and epidemiologic implications arise in smokers and that require the necessity of specific structures which may help to face up the problem. A large number of findings relate smoking to other major cardiovascular risk factors and, among this, hypertension plays a strong role that increases the harmful effects caused on cardiovascular system by smoking. However, there is no unanimous opinion on the interaction blood pressure and smoking [6-10]. Some reports identified that cigarette smoking in males was inversely related to systolic BP with, when compared to non-smokers, a reduction of 1.3 mmHg in 1.1% of light smokers, 3.8 mmHg in 3.1% of moderate smokers and 4.6 mmHg in 3.7% of heavy smokers. There was no clear relation with diastolic blood pressure. This finding was conducted in an oriental population enrolled in the study, but also in western countries blood pressure reduction was observed primarily in young smokers. In addition, some epidemiologic surveys [7, 9, 10] demonstrated that individuals who smoked a different number of cigarettes had lower blood pressure than that of non-smokers. Such a characteristic occurred in males, females, adolescents, adults and different races. However, this observation was attributed primarily to chronic smoking. There was opinion that associated loss in body weight of active smokers contributes to lowering BP. Such data contrast strongly with the results obtained in active smokers while they are smoking cigarettes as well as in dated chronic smokers [6, 11-14]. These individuals displayed an evident increase in blood pressure that seemed to be clearly related to the toxic effects of nicotine and carbon monoxide of acute type but, particularly for what concerns carbon monoxide, also of chronic type with structural arterial lesions associated. The review of Virdis et al. [15] analyzes the relationship between smoking and hypertension in an attempt to clarify this subject. Authors underline that cigarette smoking is a powerful cardiovascular risk factor and smoking cessation is the single most effective lifestyle measure for the prevention of a large number of cardiovascular diseases. Impairment of endothelial function, arterial stiffness, inflammation, lipid modification as well as an alteration of antithrombotic and prothrombotic factors are smoking-related major determinants of initiation, and acceleration of the atherothrombotic process, leading to cardiovascular events. Cigarette smoking acutely exerts an hypertensive effect, mainly through the stimulation of the sympathetic nervous system. Concerning the impact of chronic smoking on blood pressure, available data do not put clearly in evidence a direct causal relationship between these two cardiovascular risk factors, a concept supported by the evidence that no lower blood pressure values have been observed after chronic smoking cessation....