This study examined the acute effects of cigarette smoking on coronary blood vessels. Twenty-four long-term smokers underwent cardiac catheterization. Smoking one cigarette caused immediate constriction of both proximal and distal epicardial arteries of 5-8%, returning to baseline within 30 minutes. Coronary blood flow velocity decreased by 7% and resistance increased by 21% despite increased heart rate and blood pressure. The control group showed no vascular changes. Smoking acutely constricts epicardial arteries and increases coronary resistance, potentially contributing to cardiovascular harm.

1. 1
The Effect of Smoking on The Skin
By Mahboob ali khan MHA CPHQ A Quality Study on
smoking .
Acute effect of cigarette smoking on the coronary circulation: constriction of
epicardial and resistance vessels.
Abstract
OBJECTIVES:
This study was performed to determine the acute effect of cigarette smoking on
proximal and distal epicardial conduit and coronary resistance vessels.
BACKGROUND:
Cigarette smoking causes constriction of epicardial arteries and a decrease in coronary
blood flow in patients with coronary artery disease, despite an increase in myocardial
oxygen demand. The role of changes in resistance vessel tone in the acute coronary
hemodynamic effect of smoking has not been examined.
METHODS:
Twenty-four long-term smokers were studied during cardiac catheterization after
vasoactive medications had been discontinued. The effect of smoking one cigarette 10
to 15 mm long on proximal and distal conduit vessel segments was assessed before
and immediately after smoking and at 5, 15 and 30 min after smoking (n = 8). To
determine the effect of smoking on resistance vessels, coronary flow velocity was
measured in a nonobstructed artery with a 3F intracoronary Doppler catheter before and
for 5 min after smoking (n = 8). Eight patients were studied without smoking to control
for spontaneous changes in conduit arterial diameter (n = 5) and resistance vessel tone
(n = 3).
RESULTS:
The average diameter of proximal coronary artery segments decreased from 2.56 +/0.12 mm (mean +/- SEM) before smoking to 2.41 +/- 0.09 mm 5 min after smoking (-5
+/- 2%, p < 0.05). Distal coronary diameter decreased from 1.51 +/- 0.07 to 1.39 +/0.06 mm (-8 +/- 2%, p < 0.01). Marked focal vasoconstriction after smoking was
observed in two patients. Coronary diameter returned to baseline by 30 min after
smoking. There was no change in vessel diameter in control patients. Despite a
significant increase in the heart rate-mean arterial pressure product, coronary flow
velocity decreased by 7 +/- 4% (p < 0.05) and coronary vascular resistance increased
by 21 +/- 4% (p < 0.01) 5 min after smoking. There was no change in these variables in
the control subjects.

2. 2
CONCLUSIONS:
Smoking causes immediate constriction of proximal and distal epicardial coronary
arteries and an increase in coronary resistance vessel tone, despite an increase in
myocardial oxygen demand. These acute coronary hemodynamic effects may
contribute to the adverse cardiovascular consequences of cigarette smoking.
In 1985, a Dr. Douglas Model added the term "smoker’s face" to the medical dictionary
after conducting a study (published in the British Medical Journal) where he found he
was able to identify smokers (who had smoked for ten years or more) by their facial
features alone. The distinctive characteristics of a smoker’s face which tend to make
people look older than they are were called "smoker’s face" and were present in roughly
half of the smokers he surveyed, irrespective of the patient’s age, social class, exposure
to sunlight, recent change in weight and estimated lifetime consumption of cigarettes.
"Smoker’s Face" was defined as one or more of the following:
a. lines or wrinkles on the face, typically radiating at right angles from the upper and
lower lips or corners of the eyes, deeplines on the cheeks, or numerous shallow
lines on the cheeks and lower jaw.
b. A subtle gauntness of the facial features with prominence of the underlying bony
contours. Fully developed this change gives the face and ‘atherosclerotic’ (sic. A
bit like choked up blood vessels) look; lesser changes show as slight sinking of
the cheeks. In some cases these changes are associated with a leathery, worn,
or rugged appearance.
c. An atrophic, slightly pigmented grey appearance of the skin
d. A plethoric, slightly orange, purple and red complexion different from the purply
blue colour of cyanosis or the bloated appearance associated with the pseudoCushing’s changes of alcoholism"
"The fact that so many of the people with smoker’s face were fairly young indicate that
smoker’s face is not simply a symptom of age. The changes in the colour and quality of
the skin suggest a toxic process… In my experience, many people notice the ravages of
smoking for the first time when it is pointed out to them that they can be identified as
smokers by their faces alone." Dr Douglas Model, British Medical Journal (1985)

3. 3
What the toxins in cigarette smoke are doing to your skin now!
Cigarette smoke contains more than 4000 toxins many of which are absorbed directly
into the bloodstream and are taken by the blood right into the structure of your skin.
Smoking cigarettes reduces the efficiency with which the skin can regenerate itself –
smoking causes the constriction (narrowing) of the blood vessels at the top layers of the
skin which in turn reduces blood supply (to the skin). It is the reduced blood supply
which causes a reduction in the availability of oxygen (which is necessary for all living
cells) and the removal of waste products, dead cell fragments etc… which provide the
necessary environment for regeneration.
Cigarette smoking causes the blood vessels at the top layers of the skin to constrict and
so reducing the oxygen level in the blood there. This thickens the blood and reduces the
levels of collagen in the skin (it is actually because of this that smoking is also
associated with slow or incomplete healing of wounds).
In fact, smoking a single cigarette can produce cutaneous (pertaining to the skin)
vasoconstriction (decrease in the calibre of blood vessels) for up to 90 minutes. One
study suggests that blood flow in the thumb decreases about 24% after smoking one
cigarette and by 29% after two cigarettes. Another study suggested that digital (finger)
blood flow fell by an average of 42% after smoking one cigarette. A further study found
that smoking for 10 minutes decreases tissue oxygen tension for almost an hour and
concluded that the typical pack-a-day smoker would remain hypoxic* for most of each
day. (Smith and Fenske, Journal of the American Academy of Dermatol)
*hypoxic – a reduction of oxygen supply to a tissue below physiological levels despite
adequate perfusion of the tissue by blood.
Smoking makes your skin thinner
A recent British study took 25 pairs of identical twins where one twin was a lifelong
smoker and the other had never smoked. The doctors used an ultrasound technique to
gauge inner arm skin thickness. The smoker’s skin was a quarter thinner than that of
the non-smokers and in a few cases there were differences of up to 40 per cent. (Twins
study, St Thomas's Hospital)