Tonstad Serena, Svendsen Mette
Department of Preventive Cardiology, Division of Medicine, Ullevål University Hospital, Oslo, Norway.
Am J Cardiol. 2005 Dec 15;96(12):1681-5. doi: 10.1016/j.amjcard.2005.07.083. Epub 2005 Oct 28.
The metabolic syndrome and cigarette smoking each increase the risk of a recurrent event in patients with premature coronary heart disease. We explored the association between cigarette smoking and the metabolic syndrome by examining 705 men aged < 55 years and 296 women < 65 years within 6 to 12 months of a major coronary heart disease event. Most were taking statins (96%) and antihypertensive drugs (88%). Nearly 1/3 of the subjects had the full metabolic syndrome, as defined by the National Cholesterol Education Program criteria. These subjects were less likely to be nonsmokers than were those with < or = 2 components of the metabolic syndrome (13.2% vs 24.2%, p < 0.0001). After adjustment for age, educational attendance, and alcohol consumption, the odds ratio (OR) for the metabolic syndrome was doubled in men who smoked cigarettes daily (OR 2.2, 95% confidence interval 1.3 to 3.7) or who were ex-smokers (OR 2.3, 95% confidence interval 1.4 to 3.9) compared with nonsmokers. Female ex-smokers had an increased risk compared with nonsmokers (OR 2.0, 95% confidence interval 1.0 to 3.9). Ex-smokers were more likely to meet the metabolic syndrome cutoff levels for waist circumference and high-density lipoprotein cholesterol (p < or = 0.01) than were nonsmokers. Also, male ex-smokers were more likely to exceed the cutoff level for triglycerides (p = 0.004). These findings indicate that although smoking cessation is imperative for patients with premature CHD, the metabolic risks associated with overweight and obesity after cessation need to be addressed.
代谢综合征和吸烟均会增加早发性冠心病患者复发事件的风险。我们通过对705名年龄小于55岁的男性和296名年龄小于65岁的女性在发生重大冠心病事件后的6至12个月内进行检查，探讨了吸烟与代谢综合征之间的关联。大多数患者正在服用他汀类药物（96%）和抗高血压药物（88%）。按照美国国家胆固醇教育计划标准定义，近1/3的受试者患有完全代谢综合征。与代谢综合征具备≤2项组分的受试者相比，这些受试者为非吸烟者的可能性更低（13.2% 对24.2%，p<0.0001）。在对年龄、受教育程度和饮酒情况进行校正后，与非吸烟者相比，每日吸烟的男性（比值比[OR] 2.2，95%置信区间1.3至3.7）或曾经吸烟者（OR 2.3，95%置信区间1.4至3.9）发生代谢综合征的OR值翻倍。与非吸烟者相比，女性曾经吸烟者的风险增加（OR 2.0，95%置信区间1.0至3.9）。与非吸烟者相比，曾经吸烟者更有可能达到代谢综合征腰围和高密度脂蛋白胆固醇的临界值水平（p≤0.01）。此外，男性曾经吸烟者更有可能超过甘油三酯的临界值水平（p = 0.004）。这些发现表明，虽然戒烟对早发性冠心病患者至关重要，但戒烟后与超重和肥胖相关的代谢风险仍需加以关注。
