title: Pathophysiological impact of cigarette smoke exposure on the cerebrovascular system with a focus on the blood-brain barrier: expanding the awareness of smoking toxicity in an underappreciated area.
abstract: Recent evidence has indicated that active and passive cigarette smoking are associated, in a dose-dependent manner, with dysfunction of normal endothelial physiology. Tobacco smoke (TS) may predispose individuals to atherogenic and thrombotic problems, significantly increasing the risk for ischemic manifestations such as acute coronary syndrome and stroke. Despite the strong evidence for an association between smoking and vascular impairment, the impact of TS exposure on the blood-brain barrier (BBB) has only been marginally addressed. This is a major problem given that the BBB is crucial in the maintenance of brain homeostasis. Recent data have also shown that chronic smokers have a higher incidence of small vessel ischemic disease (SVID), a pathological condition characterized by leaky brain microvessels and loss of BBB integrity. In the brain TS increases the risk of silent cerebral infarction (SCI) and stroke owing to the pro-coagulant and atherogenic effects of smoking. In this article we provide a detailed review and analysis of current knowledge of the pathophysiology of tobacco smoke toxicity at the cerebrovascular levels. We also discuss the potential toxicity of recently marketed "potential-reduced exposure products".
authors.affiliation: Department of Pulmonary Medicine, Cleveland Clinic Lerner College of Medicine, E 100 St, Cleveland, OH 44106, USA. MAZZONP@ccf.org
authors.forename: Peter
authors.initials: P
authors.lastname: Mazzone
authors.forename: William
authors.initials: W
authors.lastname: Tierney
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hossain
authors.forename: Vikram
authors.initials: V
authors.lastname: Puvenna
authors.forename: Damir
authors.initials: D
authors.lastname: Janigro
authors.forename: Luca
authors.initials: L
authors.lastname: Cucullo
mesh_terms: D001812:Blood-Brain Barrier / Q000503:physiopathology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D012907:Smoking / Q000503:physiopathology*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution