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\\tlltK~llul'= ( .\f:!ttI\ 1i(l',tl\11)1 ANI) (l'I) JI:k rT t:!. l--S1 found that the prsp Jrlton of t\omcn ts ho \.erc pv~,tn)cnopatt.al was hi:.`:er ;::'1orc ,mokcrs than amJnc non<r:okers in t\ti'u Indcpen.lent st(lclles invol\•ir._ aa of 3.534 \\or.:en 45-53 \ears of:,cz. The proportion increascd by appro.i r_;el\ o:e-fourth from "ncver smoked" to those smohin, more than a pack pcr da.. Ar.al}.cs b\ marit:a sta tus. diag-nosis. or other \•ariablcs did not chance :he results. The au:hore succest as one of the possible mechanisms of the earl:,r ,:._r.orause in sr:okers :hz ir.cre:aed r..et:_bolic activity of the liver. These :..o o: ser\ations il!ustratz the c~~ rp?exit~ of the response to lor-- s:andinc c:_areae smoE:inc. L'ncoubt:dlv ^:_n\ more exist if \\e knew \\here to look for t.`.e: . Taken sincl} or in comhin:::ion. ;hev effer many possible links bzt\\e:n and atheroce:;esis. SU..','.'ARY AND CONCL 'USION Ciea:et:e =:-:okinc is associated v.ith incrz: sed extent of ad.::nced atheros:'=-os:s and \sith an increased risk- of a:herosclerotic dise;,se_ Chronic ci^_aret:e sr-O:i::_ is asso:iated \\ith a siit-,ht in.rease in total serum cholesterol conczr: 7n-::oa: \% hen anal~ zed by lipoprotzin cl-asses. LDL is increased and HDL is dzcre_-;.fd. This chan,e uo::ld ha\•e the effect of in.:reasinc atherosclerosis, particu!ari•: if :he change \\ zre present over se\ eral \ ears. Smokers `~\e slichtl\• increased er% throc\ te counts. hematocrit. and hemoclo- bin conce-:ration. It is doulltfcl \k hether the sl;,-ht changes observed appreciably increase risk oi'atherosc?trosis. Smokers a:so have elzv2;ed :eucocvtz counts. and the increase is due both to polymor ,-:`.o: uclear leucoc\ tzs and to 1\ mphoc} tes. The reason for this leucoc\ tos:s is not clear. nor is its sicniticance. but one stud\• indicstes that the leucoc\:o~:s _c-edicts m\o.ard:al infarc:ion. The leuco:.vtosis mav be one man- ifesta:ion c.` a d:sturhzd immur•,e s\stem. uhi:h deser•-es more attention as a possiblz -_c.._r.ism for a;czle:atin~ athero~er.esis. Smohers I::.\ e slichtl\• ele\ a:ed b!ooci cfu;.ose le\ els. It is not known u hether this cha-:ce :o^:;ibutes to a:herosclzrosis. Body blood press::re are lo'.\ zr in s:aol:ers ihan in nomsmol:zrs. This rzspons= to :-o.inz shou!_1 rz_'ucz the risk of _-,..:ros.:lzrotic disease. Onl\ a ii-::ed number of studizS of sr^ok-irc e:fects on the hemostatic s\,stem have been F=rfo: med. Those show lir,'.e or no effect or. proco::.-ulants. but marked effects on -"a:el_ts. SmoIa::_ t:-'_:ts on the imr:::ne s\ ste:a and on the mixed function ox~ genases of the L\zr _a:so offzr possible links ber\kezn smoking and atherosclerosis. REFERENCES 1. A:.`.e-e:.. R. .4.. -_-.d Jcssop. W. J. E.. To`_cco srr.c}.icc and ser um 1ip:ds in o!d r,:en. Bril. .\fed. J. 2. I:c_-:111 (!951). '_. L. H.. D. C.. S:-_':ones. R. A.. Ehr:i:h- S. P.. and Jo; es. J. P. E;'idcmiJlocical c. dise:.se risk :attars. I. 5'u~'. d=siz7i and charac:cris:ia of in.'.i\idjal s:udc ~..r. J. E~r.:cnti •:. 87, 3-H f li6S I 3. A-..__-._>. A. C.. san G_.... C. N I., s a- der \'oon- H-. S;e:er}:,ek. C. t.. and S:%c!o. K. RrCuce,: :`,-J;:o:eirn i.^. «or-cn a_ed ;J-:t us: .; o:A con:raceptises. Le„cet I. 1221-1223 :. Be_:.e-. C. G.. Dcbin. T. A::i\ .:io n o." c:or X;I c_s IJC ::o c!}cop:otein.J. E.ip. S1ed. 1;6. '5 ---: ~ 1 iY--1. -- ' - - - - . . . . I \ ~

IILNf(Y C. \i( (:ILI-. JR. 5. Bccl.cr. C. G.. D..!-:n. f..:,nJ H. 1'. .\',rr. AruJ. Sri. C-S .4. 73. I7I_`-1-1h 097F). 6. Billimor.a. J. D-. Poz.^.rr. H-. B. Bc>t. F. \\'.. ;,-,: J-:r-.tc,. D. C. 0. FlTr;t of ii_.,rcne sm.,:.ir: o- li; of+rot,:ir,. HaoJ co: _u:z:icn. ic:..^..):~ sis :,nd cc!!.:L,r com; .mrr.I. uf hur^1r. !~:.,.'2.A'J:,r.,irlrv,nii 21.61-:6(19-5). 7. Blaah:.rn. H.. B:aze;.. J.. Ta) lor. H. L.. ar.e.' ):ey s. A. Cn-; _risor of c:,rJios a•cuLr and re l: :cJ eh: "e:i-r:_s in h._!+::uM s-.iol.ers an' .\'. 1'. Ar,:J. Sri. 90,'_77 -=69 (1960). 8. Bror.:e-S:es•:--;. B. Cic_;eae smAir_ :.-.', isc`:::ri_ .`.c_- d. _:ae. Brit. .SlrJ. J- 1, 3:9-3,4 (1961). 9. Corr.e). A. H.. P::::,.::k. E. J.. Hs:::o. l:.-C., l:c:-:z-_n. R.. AIvares. A. P..:rr.J l::.p;as- A. R.V_.io- cf .' ~; ..._.::13:<n: in -in bt c-:2 i:.,c-._-.._, c..;:nWs and .'ict. Fc-J. Pr.,r.. Fr.L Ar,rrr. S.,c. E: + B:.,l. 36. IE-:'-1F'' t i9--). 0. Corre. F.. Le!:. _:`t. 1.. and S;h«~nz. D. 5-::.:r_ _:.t Ieu:ocyte-coent,. Re,u'.t% of an epiJc...... _ -_! sunes. Lr.r;r.. 2. E_-6:. (Iy-I). 1. Crycr. P. E.. H..•. -.w!. NL \". S.,c:i::_o. J. V..::-t S:'=.`:. S. D. Nor_P:r.carineW cpinc; hrinc relca•e c-2 c.:rt-_ _ c r..ei:::Or: of •.-m.:r._-_•so,:_::.' .`.c-3o.a namic :,^d re:aholic escnts. .\'r-, E•c.'.J. '-A•."'. 295.:---_;-. 15-6). ;f~ - '_. Dalcs. L G.. F::c,`-_n. G. D.. Sic,c;_M. A. B.. ::-A Se::z_e. C. C. Ci;arette >mol.ir.c and serLm eher.:is:rs :ests. J- D;s. 27, :93 -:0- (1S-4!. 13. Dassher. T. R.. 1:"-.-el. \\'. B.. Re•.o:;l.:e. \.. So;es. 1.. fIl. 1:n_an. A..:,nd Go:ion. T. Some (actorc asso,0e.f "i:h the des eQ; -.,r.t of cor:,-:n `e_ n.'.i,ca.e. Sie } e:r.' Wo•.+-er es; :ri- ence in :`.e F:a-ic, ham S:c.l)."4,"r. J. P:.h::r H..:...: 49, 1349- 1356 (1959). 14. Eisen. \i- E-_ and Hsm:rond. E. C. Tt.e e:Te ; of or: ,-acked cell sc,'i--:e. :eS h1 ,.d cell eour.:s. h=e-_::d ;'a:elet c, o,:s. Ccn- .;r.'. as„c. J- 75, 520-523 i 19:6i. :S. Fisch. 1. R.. and Fr.e,:can. S. H. e 7--1 cer.: __:~:ises. and obesits. E::ec:, or. uyr,e blood :c.: c.::r.:. J.01A 234. :9C-`,16 1 1975). 16. Friedmzn. G. D.. A. L.. ac' Si=ec:m:. A. B. ;: e:.ukoqte coue: as a ;:r!i_tor of m}ocard:;' \"rt .- E,r:l. J. -:Ird. ?90. 1'_"=-'.=-5 t 1971). 17. Friedman. G. D.. S e_ c1:_ub. A. B.. S,i:zer. C. C.. Fei_'-_r:- R.. and Colten. M. F. Sr-o:.icc `aNts and the ._....o:):e cour:..Arri:. Er:.:rn:. 26. (1973). 18. Garrison. R. J.. l:ac-_!. \\'- B.. Fr.r:ieb. \1.. Cas:e:i:. \\ . P"• Mc\arnara. P. SL_ and P~d^ett. S. 1. Cicare::e s::.a:i-._ 2nd HDL c^olrs:ero!. The Fra-:-;:-._r- C-spring Study. Arlrr•r„sclrr,,Srs 30, 17-'_-` (ly-c . 19. Glynn. M. F.. M.is:ard. J. F.. Bu,h;.r.an. M. R.. and ti'_•-;•:. E. A. Ci;arette smoking „d p!atelet aFcre__:io,- C:n. llcd. Assnc. J. 95. :;9-55: 1:S1V '.0. Gofman. J\V.. L:c__r_r.. F. T-. Mor.er. 0.. GiLz:e:. F". and Ta:r:p:in. A. C:,2rette smoki _ se:L- cJr:o:_1.^.s. _Ld ..:ocw, hc_-- c.-____- Mr:,r:r.-cs 10, =9--=, i lyW _'1. Goldbo:.... [:-. and \teCa'.ie. J- H- C c._..-.._s o` -.--_.*er<. r•.on-smokers -r.d es-smol.ers amom; lO.CiO cJu:: :r:aies in lsraeL II Pi::.sol._ and eer.e:ic ch:.ra:.eristi;s. Amer. J. E?:_cr, iol- 105. -5-66 ( 19-"t. 22. Gordon. T.. Czste:!i. \\`. P". Hjonland. M. C.. l:ar.ce.. V.. B-. and Dassber. T. R. Hqh densin Iipop:otem zs a prote_tis e f::ctor=;ainst coror.ar. .`.c-.. .:ae_:e- The Frar..i: ;!::,rt S:ud}'-Anzcr. J. ,tlrJ. 62. 7J'--l4 (1977). 23. Gordon. T., <ance'.. W. B., DassFer, T. R., and .s'cGee. D. Ct:anees asso::a:ed nith quit:ir.g eicanc::e sc:,l.ic_: The Frarir.c.`.am S:ud,.Ar^,•r. Hc_•-:J. 90, 322-328 (1y75)" 24. Hart. P.. Fa:-,eil. G. C-. Cooks!e), \'.'" G. E.. and Po.:e:i. L. \\". Enhar.ced dr.:^ -.c:ato!ism in I eiFare ;e s:-:~::ers. Br:t. SIeJ. J. ', 1.7-1.9 (19'6). ?5. Ha%&kins. R. 1. Sr::.li-c. pl:::e!e:s a: d Ih:oclosis. \",:::,rt ~Lo:-.Iwrt '_36, ;=0-,5' (:97'). 26. Heiman. \.• and R::henstein. L. S. T:.e e.rfe;ts of a_e, sex.-and smoking on er.:!:ro: ;es and leul.x:. tes. A,,:cr. J. C.'rr.. 63. :-` -;-: 1 1975). 27. Hit_ir.s. \t- \\"._ and laela`er.. M. C::wa;reristics er s-c:ers and r.onsmokers in Tecumseh. 51i:.`.:c_r.. IL T.`.= Jis:ri^ution of se!e;:eJ Fh..;._j .. __-c:_m,n:s and pS~siolocir sariab!es and the p:es l_..,e on ctnz:n disea;es in scc::ea =1 r.._- e s..amer. J. Ep;Jen:iol. 86, 60-77 (1967). :8. Hill. P.. and 1t _-,:e:. E. L. Smoking wd c_rdw asc:::_r d..__se- Effect of nico:in e on the serum epir.e?`.: i-.e a-.'d conicoids. .1rr:cr. Hr::rr J. S'., ;9: -::5 11974). ..opJrjr,- 1 I + ~

. \\l)RF;S I(t)1•: ( A R1tt)N \l()\O\I'1)1- `N )) ( 11) ct:n. 1'I lhr intrlL IInrl.l:i.m .+f •ir;:7. cl`otii•lCrA. iiL:~IctiC .nl.•l.in, and h+x)) t.Citl:t. -I he (.lo Stud). A1l/t llr.l. -S/.n:.:. aJV• . 9--JS ( :Y 61. ?J. Ho!t. P. G.. a,.d l:east. D. Er.: i: >r.ncr.t l!) induced chanccc in iz c:uno:o;ical fun:tion: Ac:::c ar; .rrr..:: cfrc,ts of in`t.aaa,•n of tol-z:o sr..,):.c :and o:`tcr a:r:.o~phcric contamin:u•.ts ir. man c\;c:i:r.cr.:al acim--is. B.:crrrild. Rcl•. 41.'05-116 (19%'t. 31. A. N.. P:::elski. J.. Ss++)er, D_ E.. ::nd Gresha.^.:. G. A. Athcro•aen+si• induce.' in 1 r h:; :r:.`..'zsten~l_tmic h-;:Foons by i-:-tunolo•,ical in}crc: and the cffccts of intra.eaouo phosp•`ts'id)1 chodint..arhrrr ~clrrr cis 14. 17-29 (1971). - S. \\". Sc.ori~ h~its ^C l~~on:or. tcsts. L:nc•r•• 2 15_ ( ly'0). 531S. 8.. C.>.`.e,. R.. ::n.' \\ i~do++son. G. Piasma l:po, rotein chole~tcrol le+c!. IC: 7,C:G Of .^.~w fsc:or ir.::ncr,:ion. Jrt ilA 238. „_E9-'-171( 1y1'). o. 54. 1~ ,.. H.. -'! L- Re~:.:IJCSh:, IYhlccn c1C:lrct:.. >.^,tJw: _.n.d hlch p;:cl.id ccii * Ic\e:~. Sr..r:i!. J. !/c:rvr.u7 i. S.'_,I1-_ < (19711, 13r2,... L.. __d \:..son- 1. M. S^'v7.in; ar:d fibriaol)sis. Ciri:ilu.;ur 51. 11-20-11'_? (IY7>). :6. Jer::^~. C. D.. R.>er.~:an. R. H.. :.n.l Z\zanski. S. J. Ci_:,rcttc ,m.+l:(nc. Its fcI :IJn•`.:, to ;.. .. 1`.,_.. ~:cc2se _cz! rc:r•ed riA Laors in the \\'cs:ern Cd:.,bor:,ti.e Grocp S'e.:}. Ci c: ..... '. 38. 11,0-1155 . 1965). 37~. J: .:ic:. C D.. Z.zans;i, S. J.. snd Rosennln. R. H. Biol.,;ica1• ps~:holnpicaL and -.: 1 of men .+ith srr.oi:inc NI•ul:lr Srrl . R+p- SS, S1-3-3.3 t l9-?'+. :S. Ji:i.. H.. 1.- zn.i >So7ison. A. S. Re'.a:ion betueen smol.in_ : ed :.ce of :aunl rr::nor: e. L:r:.. 1, L•=.-1 155 119""t. _9, K;,;+\l.. O-m::. E.. l:e+s. A.. Fid:,r.za. F.. and Broz,k. J. Ci,jrctte <mol.inc. sert:m- : ?-:o:,d-pressure. :.nd ho::+ fa:r.ess. La:,,( rr 1, ;9'_-,93 1 l9591. A_ C_are:te s:.^.o:.i-; and s,rum lipids in +o.)r._ rren. Eri:. 111•d. J. 1. IIIS-i116 41. P.'-i. Ar, acu:e e.rfect ofcica;et;e sr.:o;.ir:p on p'._:e:et fu::: ion. A p-ssblc Gnk tc:+,ccn _ rr.~Jsis Circul.,l: -SS. 619-6 J. C.. Li'wc1I. O. ~1.. ar.d \1'ri_h:, E. A. Scr,;m c`,:.:es:cr.+l- srr.o{ir, and hn±+ `.:d. A ssnc. in :cc Ro:al --\:: Force. Brit. J. Pr<•1'. Soc. .lfrJ. 19. 111-11-t 11965t. .3. N1cG:::. H. C-. Jr. \t`c :.i:r sis: Prub:ems in patho_cnesis. ia 'A:hcrosc: m~is Rcci.«i' 1 R. P.::r::i and A. St. Jr.. Eds.). Vol. '_- pp. 27-65. Ra+rn Press. Ne++ Yorl.. ly--. C. R.. G. E.. Car.:;.bclL W. G.. Jr. EsFerirnz:aal inSuctior, of by t`x s\: er__. of a!!e:~ic in;cn to ar.eris an.i lip i:1-rich diet. I. E`Fc: f -- ,t:ons of `orse sr:a:^ in r.:t,~i:s fcd a cho'.cster ol supl 1::::ent. J. E:r. .'.. _'. . 1_.. ^--- `~ 09561 O. D..'t.t.._. D. S.. Fo..:_. O. H.. and Vi1.-Mo. H. F:,r.:: of hich.icnsi:+ li, r~._:.l CL:~...~"... ..-j t::; rel:COn :J Lce :.n,2 se\..Ac:« Sc.....~. 201. 3 2 J-_ 19 119~ I. :6. Mc:: -: c_ L. E.. and F%ft. T- E:-fccts of c:carette sc:oi.ing on sen:m-lipids. blood-_iucose. :.;.d F:_te:c: _c'esi+e::ess. l.r:r.ce: 2. (S-2-1,14 (1966). 4-. Sl r`_.. E. A.. and ~t:a.ard. J. F. To.`acco ar.d thror^bosis. Amer. J. Public H r.!:l: :6. -iir-.i ('.956i. e :S. -_: c. J- F.. _c2 N1u., r. E. A. E.,, t _: of srr.o;in_c on blood coa;ulation and platelet surN ic_1 in o•i:. SIrJ. J. 1. ~4 6 ~9 (19 63). :9. O,,:cn. D.- Eecnec:. N. B.. zr..t O;zs:on. C. Jt_ Tre influence of c:_;areae smokinc on the ({9;0). 50. Pc,c:s- L\t., and Ftrris. B. G.. Jr. S:a.; `'olo:ical consti:ution and smoking. A funcer e+a!. :ior.. Arc%:. E^:irou:- Ncc'r;: 14• 6'6-ES1 '1. P..._..-:._. G. Fa::or< '"e ..._an sz,-,;... c!toles:erol. J. Ci:r.,nic Dis. '_3,'_89-'_97 t ly-1l. c'. Poz-_:. H.. ar.~ J. D. Effc,a of s: io:cnc on t'ood-clo;:in: ar.d lipid and _ L.:t:ce: 1. 1;15-1=21/19 0). '3. Rc 'cr. EC-- and Roth. G- \L Ef.°ect of smokin_ on the fasti::c hlood sucar and pressor 20. _.-"S ( :9:91. 54. Re:..'_ D. D.. Ho11and. \S'. \\'.• and Rose. G. A. An Anplo-Ar;criz: n caruio+ascular cor.; ::ri~or.. 2. 1 ±'5- 13-b (196-). 55. Sr. ;c .. H-. Roman. L.. Zs+od.^.i:k. J.. and Kupcrs. N. T`t effect of .mo}.ing on serum c r.. to- 0 N

? .Q-_ IILNRY C. .16lCGILL, JR. tro(+in, irau'in ..ad b!o.-J e1JCJ,c lcscls of )occr aJL I: -..._•. J. !'I:,,rrrr.,rr,1. Etp. T1,rr. ISJ, :h'-"9I (1y73). 6. Sch.. artz. D.. Rich..rrJ, 1. L.. Lc!'ouch. J., :,nd C:, :dc. J. R. Scru n li~ 's. sc; wir_ r. 1 h 4:. hc;l i study of 7,972 ac:i%c!y cm; loccd rs!es. Rru. £Jr. EruJ. Clin. E:.,1. 16. ':9 s?6 119711. 7. Smith, J. R., and S. A. SmJwc.z ; Nr„ £,::1. J. S1r.i_ _98, 6-10 t 19',1,r. 8. Stec!c, P. P.. Wcil)•, H. S.. Da%ics. H... cJ Gc-to :, E. P;a:rlct in:or,,r.rry :.^cri disc_sc. Circrrl„ri„r: 4 8, 119:-1:Ou (15-3). 9. Strore. J. P., an.l Ri:.`.irds. M. L. C,:_cac ,-:;,:ins and in oto;,icJ cr.cr.. 3:/:rn„r 1rrr,ci, 23. :51 -3'6 ( 1976). ). Szanto. S. SrrJkcr-shtiD;l)c:cmia.l. Ir. 11rJ..a;sr•c_ 58, .1. Szanto. S. Sc:olicc :,::d a;hr;o,: c;o,is. E,i:. '!,'_ J. 3. 1'6 (1557t. .2. rr:or:as. C. B. CF. ...ac i<:ia of nonscckc:s ,.. )Jun_ :,LC!is, inau,liG_ ol'iCrv:::tJ-S Or d Fre- -::rc. F.,_-: c. hJ.t\" cta!es:crul ..nd ccr,ain pa)c`s,;.•_iz :r .-;c,:. 1•:rr-rn. .S1r:!. 53. 6>--7:5 -3. T^orras. C. B. F_r-:i!ial anLa cr ^:,;. _:,. , c::s of coron f:rcr.tir. J. Cl:n,,:it Drc. 7. 19S-=CS (IY4S). ti. Thomas. C. B. On :i;,.rc:te srno~in_. corcc-_-n h,-n discLse. ani: tF.c ;..r..; i:~J, i.,:r N„pf i,rs SIr.!. J. 122. 69--6 (19E.S1. f r ~ ---- -- -- - -- - r , J J I I .._~_ ~._