Woodward M, Lam T H, Barzi F, Patel A, Gu D, Rodgers A, Suh Il
The George Institute for International Health, The University of Sydney, NSW, Australia.
Int J Epidemiol. 2005 Oct;34(5):1036-45. doi: 10.1093/ije/dyi104. Epub 2005 May 24.
Although smoking is a major risk factor for cardiovascular disease, it has been suggested that Asians may be less susceptible to the adverse effects of smoking than Caucasians. This may have contributed to the high prevalence of smoking, and the low quitting rates, in Asian men. Worldwide, smoking rates are increasing for women, amongst whom cardiovascular awareness is relatively poor.
An individual participant data analysis of 40 cohort studies was carried out, involving 463 674 Asians (33% female) and 98 664 Australasians (45% female). Cox proportional hazard models, stratified by study and sex where appropriate, were employed.
The HR [95% confidence interval (CI)], comparing current smokers with non-smokers, for coronary heart disease (CHD) was 1.60 (1.49-1.72); haemorrhagic stroke 1.19 (1.06-1.33); ischaemic stroke 1.38 (1.24-1.54). There was a clear dose-response relationship between the number of cigarettes smoked per day and both CHD and stroke, with no significant difference (P >/= 0.20) between populations from Asia and Australia/New Zealand. Although there was no sex difference for stroke in the effect of amount smoked (P = 0.16), for CHD, women tended to have higher hazard ratios than men (P = 0.011). Quitting gave a clear benefit, which was not significantly different between the sexes or regions (P > 0.63). The HR (CI) for ex-smokers compared with current smokers was 0.71 (0.64-0.78) for CHD and 0.84 (0.76-0.92) for stroke.
Unless urgent public health measures are put into place, the impact of the smoking epidemic in Asia, and among women, will be enormous. Tobacco control policies that specifically target these populations are essential.
尽管吸烟是心血管疾病的主要危险因素，但有研究表明，亚洲人可能比白种人更不易受到吸烟的不良影响。这可能是导致亚洲男性吸烟率高且戒烟率低的原因之一。在全球范围内，女性吸烟率正在上升，而她们对心血管疾病的认知相对较差。
对40项队列研究的个体参与者数据进行分析，涉及463674名亚洲人（33%为女性）和98664名澳大拉西亚人（45%为女性）。采用Cox比例风险模型，并在适当情况下按研究和性别进行分层。
与不吸烟者相比，当前吸烟者患冠心病（CHD）的风险比[95%置信区间（CI）]为1.60（1.49 - 1.72）；出血性中风为1.19（1.06 - 1.33）；缺血性中风为1.38（1.24 - 1.54）。每天吸烟数量与冠心病和中风之间存在明显的剂量反应关系，亚洲和澳大利亚/新西兰人群之间无显著差异（P≥0.20）。虽然吸烟量对中风的影响不存在性别差异（P = 0.16），但对于冠心病，女性的风险比往往高于男性（P = 0.011）。戒烟有明显益处，性别和地区之间无显著差异（P>0.63）。与当前吸烟者相比，既往吸烟者患冠心病的风险比（CI）为0.71（0.64 - 0.78），中风为0.84（0.76 - 0.92）。
除非立即采取紧急公共卫生措施，否则吸烟流行对亚洲及女性的影响将是巨大的。针对这些人群的烟草控制政策至关重要。
