The Role of Tobacco Smoking in Cutaneous Circulatory Changes Associated with Atherosclerosis

Abstract

We have shown a variety of cutaneous macro-and microcirculatory disturbances distal to sclerotic lesions (Schwartz et al., J. Vas. Surg. 1, 800, 1984). Since the majority of those patients were cigarette smokers and since smoking affects the cutaneous circulation, the purpose of this on-going project is to determine if the circulatory changes characteristic of sclerotic patients are due to the disease itself or tobacco smoking. This is being done by cross-sectional comparisons of arterial (ABF) and capillary (CBF) blood flows in the cutaneous region of the toe in groups of healthy control nonsmokers (CNS); healthy control smokers (CS); smokers who have atherosclerosis in the femoral tree (AS); and nonsmokers who have femoral atherosclerosis (ANS). All groups are being matched according to age and gender. The smoker groups are also matched in accordance with smoking history. This presentation gives preliminary results of the first three groups. The rank order of ABF both at rest and at peak reactive hyperemia following a 1 min period of ischemia thus far is: CNS > CS > AS. The CS and AS values are significantly lower compared to the CNS group (P ≤ 0.10). At the microcirculatory level resting CBF per vessel has been similar among the groups, but the AS group has had a higher capillary density such that estimated total capillary perfusion (flow per vessel x density) is higher in this group. Despite this, the AS subjects have had a lower reactive hyperemia of CBF both in terms of absolute values and percent change (p ≤ 0.05). These preliminary results suggest that habitual tobacco smoking per se elicits changes in cutaneous arterial blood flow directionally similar to those seen in smokers who have atherosclerosis, but post-lesion microcirculatory changes seem to be a manifestation of the disease itself and are not related to tobacco smoking.