The Multifocal Atherosclerosis in Active Smokers Compared to Patients Who Used THS - Elizaveta Skorodumova PhD

Background According to modern data, "multifocal atherosclerosis" (MFA) is a hemodynamically significant atherosclerotic damage of arteries. To assess the MFA, the patient was assessed on three scales: Diamond-Forrester, Duke model, SADC2. The Duke model had the maximum efficiency in predicting atherosclerotic dammage (92.5±3.43%), Diamond-Forrester was in second place - 84.2±2.2%, and CADC2 was in third place -64.2±4.4% . All presented scales had a limitation - they were developed to assess stenosing atherosclerosis of the coronary arteries and could only theoretically serve as a guideline for MFA screening. The purpose of the study was to assess the effect of smoking on lipid profile parameters and the development of multifocal atherosclerosis in active smokers Materials and methods The study included 102 patients with stable angina (62 male (60.8%) and 40 female (39.2%), mean age 64.2±12.7 years, mean smoking history 10.2±3.4 52 patients had multifocal atherosclerosis, which corresponded to the minimum level of statistical significance p<0.05 according to the method of K.A. Otdelnova. The basis for the MFA detection scale was taken from the Diamond-Forrester, Duke, CADC models for assessing the risk of coronary artery stenosis, as well as the SMART scale, since endpoint predictors should be associated with atherosclerosis, however, such a relationship was statistically significant only for total cholesterol ( TC) (r=0.519; p<0.001), low-density lipoproteins (LDL) (r=0.586; p<0.001), gender (r=0.195; p=0.049). The atherogenic coefficient (CA), not included in these scales, had a fairly high correlation coefficient r=0.384 (p=0.048). The sample of patients was divided into two subgroups. 1. Patients who smoked traditional cigarettes - n=70 2. Patients using tobacco heating systems n=32 Results The development of MFA had an effect 6,77 times higher on the blood’s level of TC, compared with the opposite situation, the same is true for LDL (4.94 times). The degree of mutual influence of factors and multifocal atherosclerosis looked as follows. For total cholesterol, the influence of the factor on the development of multifocal atherosclerosis was 3.549 at p=0.040, while the reverse situation was 24.012 at p<0.001; thus leading to a ratio of 1:6.77; the same pattern is typical for LDL - Factor → MFA - 3.593 at p=0.032, while MFA → factor 17.744 at p<0.001. The same pattern was observed for KA: 4.318 p=0.048 and 4.165 at p=0.023 The CA level had a mutual influence of 1:1.04. The level of high density lipoproteins did not affect the development of MFA (F=1.80, p=0.19). In patients with MFA, the male predominated (F=3.960, p=0.049). This model was tested using ROC analysis: the area under the curve was 0.798, which corresponded to a “good” score on the area under the curve scale. As a result, various degrees of severity of multifocal atherosclerosis in patients were revealed. In a sample of cigarette smokers, the number of patients with severe multifocal atherosclerosis was statistically significantly higher than with alternative methods of nicotine delivery: 54 (77.1%) cases versus 145 (43.8%) cases. Conclusion 1) Multifocal atherosclerosis is a factor that increases the blood content of TC (6.77:1) and LDL (4.94:1); 2) In male the risk of developing MFA is higher than in female (1.037:1). 3) The use of tobacco heating systems in patients who are not motivated to quit smoking may reduce the risk of developing multifocal atherosclerosis and the associated increase in cholesterol and LDL