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The first study examined dogs affected by myxomatous mitral valve disease and found that individuals living in households with smokers exhibited statistically significantly lower plasma concentrations of tetrahydrobiopterin (p=0.01) [a cofactor for endothelial-derived vasodilator nitric oxide, whose depletion is associated with oxidative stress], suggesting that passive smoke exposure may contribute to oxidative imbalance 37

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That means cigarettes may still reclaim the top spot by years end

There is no burning tobacco, no smoke smell, and it can be done discreetly (sometimes in the back of the classroom)

For example, research published in Nature Medicine demonstrated that nicotine stimulates the vagus nerve, and, by extension, nicotinic receptors, reducing inflammatory cytokine production in models of sepsis