Superior Myocardial Protection Using "Polarizing" Adenosine, Lidocaine, and Mg2+ Cardioplegia in Humans.

Smoking has a significant impact on patients with FMD. Diagnosis of FMD may have been delayed in patients who had ever smoked, because symptoms could have been attributed to smoking-related disease. Smokers with FMD had significantly higher rates of claudication, aneurysm, and need for therapeutic intervention. Of note, therapeutic interventions for non-FMD indications were excluded from analysis, and the arteries on which therapeutic interventions were performed were consistent with the arterial beds with FMD involvement. Thus, atherosclerosis is not the driver of therapeutic interventions in smokers with FMD. Smokers also tended to have an increase in the prevalence of major vascular events (42.8% vs 36.8%, p 1⁄4 0.077). A multivariate logistic regression adjusting for age at diagnosis, sex, and other characteristics also did not show statistical significance (odds ratio: 1.16; 95% confidence interval: 0.86 to 1.57; p 1⁄4 0.34). Lack of statistical significance could reflect the lack of power to detect this association in a cohort of 949 patients with FMD. The high prevalence of aneurysms is concerning. Although it is well known that smoking is associated with aneurysms, smoking also appears to increase the risk for aneurysms in patients with FMD, a population in which the risk for aneurysmal disease is already significant (4). Screening for intracranial aneurysms in all patients with FMD is recommended (5); however, the method of screening for aneurysm in other vascular beds is yet undefined. The recently published scientific statement on FMD (5) lists the creation of a vascular screening approach for patients with FMD as a top research priority. The present study emphasizes the importance of screening, particularly for aneurysm, and particularly in patients with histories of smoking.