中老年男性吸烟状况与心血管疾病发生风险的关联性
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摘要
目的探讨中老年男性吸烟状况与心血管疾病(cardiovascular disease,CVD)及其亚型发生风险的关联性。方法本研究选取东风-同济(Dongfeng-Tongji,DFTJ)队列中基线未患冠心病(coronary heart disease,CHD)、中风、癌症、严重心电图异常的13 940名男性为研究对象。研究对象均完成了基线调查,包括问卷调查、体格检查、生化指标检查和血液样本采集。采用Cox比例风险回归模型进行关联性分析,计算风险比(hazard ratio,HR)和95%置信区间(confidence intervals,CI)。结果多因素调整后,与从不吸烟者相比,现在吸烟者发生CVD、CHD和中风的风险增加,吸烟指数≥40包年者发生CVD、CHD和中风的风险HR值分别为1. 49 (95%CI:1. 32～1. 68,P_(trend)=0. 001)、1. 40 (95%CI:1. 22～1. 62,P_(trend)=0. 026)和1. 59 (95%CI:1. 26～2. 00,P_(trend)=0. 029),开始吸烟年龄<20岁者发生CVD和CHD的风险HR值分别为1. 29 (95%CI:1. 06～1. 58,P_(trend)=0. 007)和1. 30 (95%CI:1. 03～1. 64,P_(trend)=0. 010);与现在吸烟者相比,戒烟时长≥10年者发生CVD和中风的风险显著降低,HR值分别为0. 80 (95%CI:0. 71～0. 91,P_(trend)=0. 017)和0. 65(95%CI:0. 50～0. 84,P_(trend)=0. 207)。结论吸烟能增加CVD、CHD和中风的发生风险,且吸烟指数越大或开始吸烟年龄越小,CVD发生风险越高。戒烟可降低CVD和中风的发生风险。
Objective To investigate the association of smoking status with incident cardiovascular disease( CVD) and its subtypes among the middle-aged and older male populations. Methods This study included 13 940 males from Dongfeng-Tongji( DFTJ) cohort who were free of coronary heart disease( CHD),stroke,cancer or severely abnormal electrocardiogram( ECG) at baseline. All participants completed baseline questionnaires,physical examinations,clinical biochemical tests and blood sample collection. Cox proportional hazard models were used to estimate the hazard ratios( HRs) and 95% confident intervals( CI) for the association analyses. Results Compared with never smokers,current smokers had significant higher risks of CVD,CHD and stroke,the adjusted HRs of current smokers who smoked for more than 40 pack-years were 1. 49( 95% CI: 1. 32-1. 68,P_(trend)= 0. 001),1. 40( 95%CI: 1. 22-1. 62,P_(trend)= 0. 026) and 1. 59( 95% CI: 1. 26-2. 00,P_(trend)= 0. 029) for CVD,CHD and stroke,respectively; and the adjusted HRs of current smokers who started smoking before 20 years old were 1. 29( 95% CI: 1. 06-1. 58,P_(trend)= 0. 007) and 1. 30( 95% CI: 1. 03-1. 64,P_(trend)= 0. 010)for CVD and CHD,respectively. Former smokers who had quitted smoking for 10 or more years had significant lower risks of CVD( HR: 0. 80,95% CI: 0. 71-0. 91,P_(trend)= 0. 017) and stroke( HR: 0. 65,95% CI: 0. 50-0. 84,P_(trend)= 0. 207) when comparing to current smokers. Conclusions Smoking is significantly associated with higher risks of CVD,CHD and stroke,and greater amount of smoking and earlier age at smoking initiation are associated with a higher risk of CVD. Smoking cessation can reduce the risk of CVD.
Objective To investigate the association of smoking status with incident cardiovascular disease( CVD) and its subtypes among the middle-aged and older male populations. Methods This study included 13 940 males from Dongfeng-Tongji( DFTJ) cohort who were free of coronary heart disease( CHD),stroke,cancer or severely abnormal electrocardiogram( ECG) at baseline. All participants completed baseline questionnaires,physical examinations,clinical biochemical tests and blood sample collection. Cox proportional hazard models were used to estimate the hazard ratios( HRs) and 95% confident intervals( CI) for the association analyses. Results Compared with never smokers,current smokers had significant higher risks of CVD,CHD and stroke,the adjusted HRs of current smokers who smoked for more than 40 pack-years were 1. 49( 95% CI: 1. 32-1. 68,P_(trend)= 0. 001),1. 40( 95%CI: 1. 22-1. 62,P_(trend)= 0. 026) and 1. 59( 95% CI: 1. 26-2. 00,P_(trend)= 0. 029) for CVD,CHD and stroke,respectively; and the adjusted HRs of current smokers who started smoking before 20 years old were 1. 29( 95% CI: 1. 06-1. 58,P_(trend)= 0. 007) and 1. 30( 95% CI: 1. 03-1. 64,P_(trend)= 0. 010)for CVD and CHD,respectively. Former smokers who had quitted smoking for 10 or more years had significant lower risks of CVD( HR: 0. 80,95% CI: 0. 71-0. 91,P_(trend)= 0. 017) and stroke( HR: 0. 65,95% CI: 0. 50-0. 84,P_(trend)= 0. 207) when comparing to current smokers. Conclusions Smoking is significantly associated with higher risks of CVD,CHD and stroke,and greater amount of smoking and earlier age at smoking initiation are associated with a higher risk of CVD. Smoking cessation can reduce the risk of CVD.
引文
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[15]申倩,祝楠波,余灿清,等.中国成年人吸烟与心血管疾病发病风险的关联及其性别差异分析[J].中华流行病学杂志,2018,39(1):8-15.DOI:10.3760/cma.j.issn.0254-6450.2018.01.002.Shen Q,Zhu NB,Yu CQ,et al.Sex-specific associations between tobacco smoking and risk of cardiovascular diseases in Chinese adults[J].Chin J Epidemiol,2018,39(1):8-15.DOI:10.3760/cma.j.issn.0254-6450.2018.01.002.
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[17]Xu T,Bu X,Li H,et al.Smoking,heart rate,and ischemic stroke:a population-based prospective cohort study among Inner Mongolians in China[J].Stroke,2013,44(9):2457-2461.DOI:10.1161/STROKEAHA.111.000648.
[18]Liu J,Hong Y,D'Agostino RS,et al.Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese multi-provincial cohort study[J].JAMA,2004,291(21):2591-2599.DOI:10.1001/jama.291.21.2591.
[19]Kelly TN,Gu D,Chen J,et al.Cigarette smoking and risk of stroke in the Chinese adult population[J].Stroke,2008,39(6):1688-1693.DOI:10.1161/STROKEAHA.107.505305.
[20]Tse LA,Fang XH,Wang WZ,et al.Incidence of ischemic and hemorrhagic stroke and the association with smoking and smoking cessation:a 10-year multicentre prospective study in China[J].Public Health,2012,126(11):960-966.DOI:10.1016/j.puhe.2012.07.010.
[21]Wang F,Zhu J,Yao P,et al.Cohort profile:the Dongfeng-Tongji cohort study of retired workers[J].Int J Epidemiol,2013 42(3):731-740.DOI:10.1093/ije/dys053.
[22]Israel RA.International Classification of Diseases(ICD)[M].John Wiley&Sons,Ltd,2011,31-36.
[23]Luepker RV,Apple FS,Christenson RH,et al.Case definitions for acute coronary heart disease in epidemiology and clinical research studies:a statement from the AHA Council on Epidemiology and Prevention;AHA Statistics Committee;World Heart Federation Council on Epidemiology and Prevention;the European Society of Cardiology Working Group on Epidemiology and Prevention;Centers for Disease Control and Prevention;and the National Heart,Lung,and Blood Institute[J].Circulation,2003,108(20):2543-2549.DOI:10.1161/01.CIR.0000100560.46946.EA.
[24]Yuan Y,Xiao Y,Feng W,et al.Plasma metal concentrations and incident coronary heart disease in Chinese adults:the DongfengTongji cohort[J].Environ Health Perspect,2017,125(10):107007.DOI:10.1289/EHP1521.
[25]Anderson JL,Adams CD,Antman EM,et al.2012 ACCF/AHAfocused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction:a report of the American college of cardiology foundation/American heart association task force on practice guidelines[J].Circulation,2013,127(23):e663-e828.DOI:10.1161/CIR.0b013e31828478ac.
[26]Walker AE,Robins M,Weinfeld FD.The national survey of stroke.Clinical findings[J].Stroke,1981,12(Suppl 1):I13-I44.DOI:info:doi/10.1016/S0378-7788(02)00061-0.
[27]Sacco RL,Kasner SE,Broderick JP,et al.An updated definition of stroke for the 21st century:a statement for healthcare professionals from the American heart association/American stroke association[J].Stroke,2013,44(7):2064-2089.DOI:10.1161/STR.0b013e318296aeca.
[28]Nitika,Mishra SS,Lohani P.Lexis expansion:a prerequisite for analyzing time changing variables in a cohort study[J].Nepal JEpidemiol,2017,7(2):681-684.DOI:10.3126/nje.v7i2.17974.
[29]赵洁雯,要鹏韬,刘黎香.北京市吸烟人群尼古丁依赖程度影响因素的横断面调查研究[J].中华疾病控制杂志,2018,22(4):358-362.DOI:10.16462/j.cnki.zhjbkz.2018.04.009.Zhao JW,Yao PT,Liu LX.The epidemiological investigation on risk factors of nicotine dependence among the smokers in Beijing[J].Chin J Dis Control Prev,2018,22(4):358-362.DOI:10.16462/j.cnki.zhjbkz.2018.04.009.
[2]国家心血管病中心.中国心血管病报告,2017[M].北京:中国大百科全书出版社,2017:190.National Center for Cardiovascular Disease.Report on cardiovascular diseases in China,2017[M].Beijing:Encyclopedia of China Publishing House,2017:190.
[3]GBD 2015 Tobacco Collaborators.Smoking prevalence and attributable disease burden in 195 countries and territories,1990-2015:a systematic analysis from the global burden of disease study2015[J].Lancet,2017,389(10082):1885-1906.DOI:10.1016/S0140-6736(17)30819-X.
[4]Hackshaw A,Morris JK,Boniface S,et al.Low cigarette consumption and risk of coronary heart disease and stroke:meta-analysis of 141 cohort studies in 55 study reports[J].BMJ,2018,360:j5855.DOI:10.1136/bmj.j5855.
[5]Mc Evoy JW,Blaha MJ,De Filippis AP,et al.Cigarette smoking and cardiovascular events:role of inflammation and subclinical atherosclerosis from the multi-ethnic study of atherosclerosis(ME-SA)[J].Arterioscler Thromb Vasc Biol,2015,35(3):700-709.DOI:10.1161/ATVBAHA.114.304562.
[6]Huxley RR,Yatsuya H,Lutsey PL,et al.Impact of age at smoking initiation,dosage,and time since quitting on cardiovascular disease in African Americans and whites:the atherosclerosis risk in communities study[J].Am J Epidemiol,2012,175(8):816-826.DOI:10.1093/aje/kwr391.
[7]Gellert C,Schottker B,Muller H,et al.Impact of smoking and quitting on cardiovascular outcomes and risk advancement periods among older adults[J].Eur J Epidemiol,2013,28(8):649-658.DOI:10.1007/s10654-013-9776-0.
[8]Mons U,Müezzinler A,Gellert C,et al.Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults:meta-analysis of individual participant data from prospective cohort studies of the chances consortium[J].BMJ,2015,350:h1551.DOI:10.1136/bmj.h1551.
[9]Kenfield SA,Stampfer MJ,Rosner BA,et al.Smoking and smoking cessation in relation to mortality in women[J].JAMA,2008,299(17):2037-2047.DOI:10.1001/jama.299.17.2037.
[10]Christensen CH,Rostron B,Cosgrove C,et al.Association of cigarette,cigar,and pipe use with mortality risk in the US population[J].JAMA Intern Med,2018,178(4):469-476.DOI:10.1001/jamainternmed.2017.8625.
[11]Inoue-Choi M,Liao LM,Reyes-Guzman C,et al.Association of long-term,low-intensity smoking with all-cause and cause-specific mortality in the national institutes of health-AARP diet and health study[J].JAMA Intern Med,2017,177(1):87-95.DOI:10.1001/jamainternmed.2016.7511.
[12]Gellert C,Schottker B,Brenner H.Smoking and all-cause mortality in older people:systematic review and meta-analysis[J].Arch Intern Med,2012,172(11):837-844.DOI:10.1001/archinternmed.2012.1397.
[13]Chen Z,Peto R,Zhou M,et al.Contrasting male and female trends in tobacco-attributed mortality in China:evidence from successive nationwide prospective cohort studies[J].Lancet,2015,386(10002):1447-1456.DOI:10.1016/S0140-6736(15)00340-2.
[14]Xu L,Schooling CM,Chan WM,et al.Smoking and hemorrhagic stroke mortality in a prospective cohort study of older Chinese[J].Stroke,2013,44(8):2144-2149.DOI:10.1161/STROKEAHA.113.001500.
[15]申倩,祝楠波,余灿清,等.中国成年人吸烟与心血管疾病发病风险的关联及其性别差异分析[J].中华流行病学杂志,2018,39(1):8-15.DOI:10.3760/cma.j.issn.0254-6450.2018.01.002.Shen Q,Zhu NB,Yu CQ,et al.Sex-specific associations between tobacco smoking and risk of cardiovascular diseases in Chinese adults[J].Chin J Epidemiol,2018,39(1):8-15.DOI:10.3760/cma.j.issn.0254-6450.2018.01.002.
[16]Ji J,Pan E,Li J,et al.Classical risk factors of cardiovascular disease among Chinese male steel workers:a prospective cohort study for 20 years[J].BMC Public Health,2011,11:497.DOI:10.1186/1471-2458-11-497.
[17]Xu T,Bu X,Li H,et al.Smoking,heart rate,and ischemic stroke:a population-based prospective cohort study among Inner Mongolians in China[J].Stroke,2013,44(9):2457-2461.DOI:10.1161/STROKEAHA.111.000648.
[18]Liu J,Hong Y,D'Agostino RS,et al.Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese multi-provincial cohort study[J].JAMA,2004,291(21):2591-2599.DOI:10.1001/jama.291.21.2591.
[19]Kelly TN,Gu D,Chen J,et al.Cigarette smoking and risk of stroke in the Chinese adult population[J].Stroke,2008,39(6):1688-1693.DOI:10.1161/STROKEAHA.107.505305.
[20]Tse LA,Fang XH,Wang WZ,et al.Incidence of ischemic and hemorrhagic stroke and the association with smoking and smoking cessation:a 10-year multicentre prospective study in China[J].Public Health,2012,126(11):960-966.DOI:10.1016/j.puhe.2012.07.010.
[21]Wang F,Zhu J,Yao P,et al.Cohort profile:the Dongfeng-Tongji cohort study of retired workers[J].Int J Epidemiol,2013 42(3):731-740.DOI:10.1093/ije/dys053.
[22]Israel RA.International Classification of Diseases(ICD)[M].John Wiley&Sons,Ltd,2011,31-36.
[23]Luepker RV,Apple FS,Christenson RH,et al.Case definitions for acute coronary heart disease in epidemiology and clinical research studies:a statement from the AHA Council on Epidemiology and Prevention;AHA Statistics Committee;World Heart Federation Council on Epidemiology and Prevention;the European Society of Cardiology Working Group on Epidemiology and Prevention;Centers for Disease Control and Prevention;and the National Heart,Lung,and Blood Institute[J].Circulation,2003,108(20):2543-2549.DOI:10.1161/01.CIR.0000100560.46946.EA.
[24]Yuan Y,Xiao Y,Feng W,et al.Plasma metal concentrations and incident coronary heart disease in Chinese adults:the DongfengTongji cohort[J].Environ Health Perspect,2017,125(10):107007.DOI:10.1289/EHP1521.
[25]Anderson JL,Adams CD,Antman EM,et al.2012 ACCF/AHAfocused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction:a report of the American college of cardiology foundation/American heart association task force on practice guidelines[J].Circulation,2013,127(23):e663-e828.DOI:10.1161/CIR.0b013e31828478ac.
[26]Walker AE,Robins M,Weinfeld FD.The national survey of stroke.Clinical findings[J].Stroke,1981,12(Suppl 1):I13-I44.DOI:info:doi/10.1016/S0378-7788(02)00061-0.
[27]Sacco RL,Kasner SE,Broderick JP,et al.An updated definition of stroke for the 21st century:a statement for healthcare professionals from the American heart association/American stroke association[J].Stroke,2013,44(7):2064-2089.DOI:10.1161/STR.0b013e318296aeca.
[28]Nitika,Mishra SS,Lohani P.Lexis expansion:a prerequisite for analyzing time changing variables in a cohort study[J].Nepal JEpidemiol,2017,7(2):681-684.DOI:10.3126/nje.v7i2.17974.
[29]赵洁雯,要鹏韬,刘黎香.北京市吸烟人群尼古丁依赖程度影响因素的横断面调查研究[J].中华疾病控制杂志,2018,22(4):358-362.DOI:10.16462/j.cnki.zhjbkz.2018.04.009.Zhao JW,Yao PT,Liu LX.The epidemiological investigation on risk factors of nicotine dependence among the smokers in Beijing[J].Chin J Dis Control Prev,2018,22(4):358-362.DOI:10.16462/j.cnki.zhjbkz.2018.04.009.
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