Circulating endothelial-coagulative activation markers after smoking cessation: a 12-month observational study


Prof. Riccardo Polosa, Centro per la Prevenzione e Cura del Tabagismo, Azienda Ospedaliero-Universitaria Ospedali Vittorio Emanuele – Ferrarotto – Santo Bambino, 95124 Catania, Italy. Tel.: +39 095 7435703; fax: +39 095 326718; e-mail:


Eur J Clin Invest 2011; 41 (6): 616–626


Background  Cigarette smoking is associated with cardiovascular morbidity and mortality. Exposure to cigarette smoke can cause endothelial dysfunction with impaired endothelium-dependent vasodilation and ‘endothelial activation’, which predispose to atherothrombosis. The effects of continued smoking and smoking cessation on the level of endothelial, platelet and clotting activation have not been described previously. Here, we prospectively monitored changes in circulating endothelial-coagulative activation markers in smokers undertaking smoking cessation.

Method  This 12-month prospective study of 174 smokers with no commonly acquired atherothrombotic risk factors underwent an intensive smoking-cessation programme investigating the effect of quitting on circulating levels of von Willebrand’s Factor Antigen (vWF:Ag), soluble Thrombomodulin (sTM), d-Dimer (d-D), prothrombin fragment F1 + 2 (F1 + 2), platelet factor-4 (PF4) and β-Thromboglobulin (β-TG). Blood samples and study measures were collected and compared at baseline and at 2, 6 and 12 months after smoking cessation from quitters and relapsers’.

Results  No significant differences in demographic or laboratory parameters at baseline were observed between the study groups. Significant changes in von Willebrand’s Factor activity were observed at 2 months after smoking cessation, with levels decreasing from 141·8% to 113·6%. Substantial modifications in d-Dimer, prothrombin fragment F1 + 2, platelet factor-4 and β-thromboglobulin concentrations were observed only at 6 and 12 months after smoking cessation. Positive associations between baseline levels of these biomarkers and number of pack per years have been demonstrated.

Conclusions  Chronic exposure to cigarette smoke sustains the activation of the endothelial-coagulative system and abstinence may result in the improvement of several endothelial-coagulative abnormalities in regular smokers. This may translate into an overall decline in cardiovascular risk.