Dr. Sarrel describes how smoking damages a woman's heart.
How does smoking affect the artery’s ability to stay dilated? There’s a beautiful study that shows it. The way an artery stays open is that there are cells lining the artery and these cells produce a chemical called nitric oxide – easy symbol to remember – NO, that’s it.
What nitric oxide does is dilate blood vessels. I won’t go into all the mechanisms through which it does that but if somebody has say a heart condition they use an under-the-tongue pill, and that under-the-tongue pill is nitric oxide – GTN is nitro. Your arteries, men and women, are producing nitro all the time. If we didn’t; we’d be dead all of the time.
So in fact, this is a normal mechanism that has evolved through hundreds of millions of years. Horseshoe crabs, 400 million years old, still have nitric oxide keeping their arteries open. That’s how long the mechanism has been in place. We know that there are many things that stimulate the production of nitric oxide.
One of the things that smoking does is inhibit its production. A beautiful study that shows this was done at the Tuft’s New England Medical School where they measured blood flow in the fingertip using a light beam, had smokers smoke a cigarette and run on a treadmill, and it takes about 10 to 12 minutes to show the artery constricts and you don’t even get enough, the fingers turn white and so the blood flow disappears. The impact of smoking is almost immediate to make the artery constrict; it is inhibiting the nitro from the dilation.
Now, there’s another effect of smoking; it affects estrogen metabolism. So in fact, smokers produce an enzyme in their liver that destroys their body’s estrogen and all those protective effects that estrogen could have, for example, one of the actions of estrogen is to stimulate the cells in the arteries to make nitro – that’s one of its 25 different actions in the wall of an artery.
So in fact, you can show taking an estrogen tablet will induce blood flow to increase but the amount of estrogen available is compromised by smoking, and smoking’s action there is in the liver to make an enzyme that destroys their estrogen.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.