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Abstract
Background: After excess
weight, smoking may be the
second most common cause of
vasculitis all over the world.
Methods:
All patients with sickle cell
diseases (SCD) were studied.
Results:
We included 222 males and
212 females with similar ages
(30.8 vs 30.3 years, p>0.05,
respectively). Smoking (23.8%
vs 6.1%, p<0.001), alcohol
(4.9% vs 0.4%, p<0.001),
transfused red blood cells
(RBC) in their lives (48.1
vs 28.5 units, p=0.000), disseminated
teeth losses (5.4% vs 1.4%,
p<0.001), ileus (7.2% vs
1.4%, p<0.001), chronic
obstructive pulmonary disease
(COPD) (25.2% vs 7.0%, p<0.001),
cirrhosis (8.1% vs 1.8%, p<0.001),
leg ulcers (19.8% vs 7.0%,
p<0.001), clubbing (14.8%
vs 6.6%, p<0.001), coronary
heart disease (18.0% vs 13.2%,
p<0.05), chronic renal
disease (9.9% vs 6.1%, p<0.05),
and stroke (12.1% vs 7.5%,
p<0.05) were higher in
males.
Conclusion:
The hardened RBC-induced capillary
endothelial damage initiates
at birth, and terminates with
leg ulcers-like atherosclerotic
endpoints even at childhood
in SCD. Similarly, smoking
causes a systemic inflammation
on vascular endothelium terminating
with an accelerated atherosclerosis-induced
end-organ insufficiencies
in whole body. Its atherosclerotic
effect is the most obvious
in the COPD and Buerger’s
disease, probably due to the
higher concentrations of toxic
substances in lungs and pooling
of blood in lower extremities.
Since the already developed
vascular stenoses are irreversible
in Buerger’s disease,
anti-inflammatory dose of
aspirin plus low-dose warfarin
may be the best treatment
regimen to protect fingers
and toes from acute infarctions.
The regimen may even increase
the leg performance by preventing
acute ischemias in microcirculation
of the legs.
Key
words: Buerger’s
disease, smoking, leg performance,
sickle cell diseases, leg
ulcers, anti-inflammatory
dose of aspirin, low-dose
warfarin
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