Cancers of the Gastrointestinal Tract

Similar฀results฀have฀been฀obtained฀in฀further฀studies฀ [340–344] .฀Smoking฀cessation฀could฀ eliminate฀25฀of฀deaths฀from฀pancreatic฀cancer฀in฀the฀United฀States฀ [343] .฀Current฀cigar฀ smoking,฀especially฀when฀the฀smoke฀is฀inhaled,฀is฀also฀associated฀with฀an฀increased฀risk฀ for฀pancreatic฀cancer฀RR฀=฀2.7;฀CI:฀1.5–4.8฀ [345] .

7.6 Urinary Tract Diseases

Along฀with฀the฀lungs฀and฀heart,฀kidneys฀are฀among฀the฀most฀important฀target฀organs฀for฀the฀ harmful฀effects฀of฀smoking.฀In฀terms฀of฀preserving฀renal฀function฀in฀an฀older฀population,฀ smoking฀is฀counterproductive฀because฀pre-existing฀hypertension฀and฀vascular฀disease,฀in฀ tandem฀with฀smoking,฀will฀damage฀small฀and฀large฀renal฀vessels,฀even฀in฀patients฀without฀ diabetes฀ [346] .฀As฀long฀ago฀as฀1907,฀the฀German฀physician฀Hesse฀advised฀his฀patients฀with฀ nephrosclerosis฀to฀give฀up฀smoking฀ [347] . Sections฀of฀myocardium฀and฀kidney฀from฀autopsied฀subjects฀display฀parallel฀smoking- related฀changes฀in฀terms฀of฀increased฀intima฀thickness฀of฀small฀vessels;฀while฀the฀degree฀of฀ increase฀did฀not฀correlate฀with฀pack-years,฀it฀did฀show฀a฀positive฀correlation฀with฀age฀in฀the฀ kidney฀ [348] .฀ Within-subject฀ variability฀ has฀ so฀ far฀ limited฀ the฀ usefulness฀ of฀ biomarker฀ determinations฀ –฀ e.g.฀ microalbumin,฀ N-acetyl-b- d -glucosaminidase฀ NAG฀ and฀ alanine฀ aminopeptidase฀AAP฀–฀for฀the฀diagnosis฀of฀renal฀function฀ [349] .฀Whereas฀acute฀smoking฀ has฀been฀reported฀to฀have฀no฀inluence฀on฀renal฀albumin฀excretion฀ [350] ,฀microalbuminu- ria฀is฀already฀increased฀in฀the฀presence฀of฀diabetic฀changes฀see฀Sect.฀7.4.2.2. Smoking-induced฀elevations฀in฀blood฀pressure฀and฀heart฀rate฀result฀from฀increased฀secre- tion฀of฀arginine฀vasopressin฀and฀adrenaline,฀whereas฀glomerular฀iltration฀rate฀GFR฀falls฀with฀ a฀simultaneous฀increase฀in฀renal฀vascular฀resistance฀Fig.฀ 7.5 ฀ [351] .฀Overall,฀non-smokers฀ MAP HR GFR ERPF RVR −20 −10 10 20 Nicotine-induced changes [] 30 Nonsmoker smoker 40 Fig. 7.5 ฀฀฀Mean฀percentage฀ changes฀in฀mean฀arterial฀ pressure฀MAP,฀heart฀rate฀ HR,฀glomerular฀iltration฀ rate฀GFR,฀effective฀renal฀ plasma฀low฀ERPF฀and฀ renal฀vascular฀resistance฀ RVR฀in฀9฀smokers฀and฀฀ 10฀non-smokers฀following฀ administration฀of฀4-mg฀ nicotine฀chewing฀gum฀for฀฀ 30฀min฀ [351]