Houston Thomas K, Person Sharina D, Pletcher Mark J, Liu Kiang, Iribarren Carlos, Kiefe Catarina I
Deep South Center on Effectiveness Research, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
BMJ. 2006 May 6;332(7549):1064-9. doi: 10.1136/bmj.38779.584028.55. Epub 2006 Apr 7.
To assess whether active and passive smokers are more likely than non-smokers to develop clinically relevant glucose intolerance or diabetes.
Coronary artery risk development in young adults (CARDIA) is a prospective cohort study begun in 1985-6 with 15 years of follow-up.
Participants recruited from Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California, USA.
Black and white men and women aged 18-30 years with no glucose intolerance at baseline, including 1386 current smokers, 621 previous smokers, 1452 never smokers with reported exposure to secondhand smoke (validated by serum cotinine concentrations 1-15 ng/ml), and 1113 never smokers with no exposure to secondhand smoke.
Time to development of glucose intolerance (glucose > or = 100 mg/dl or taking antidiabetic drugs) during 15 years of follow-up.
Median age at baseline was 25, 55% of participants were women, and 50% were African-American. During follow-up, 16.7% of participants developed glucose intolerance. A graded association existed between smoking exposure and the development of glucose intolerance. The 15 year incidence of glucose intolerance was highest among smokers (21.8%), followed by never smokers with passive smoke exposure (17.2%), and then previous smokers (14.4%); it was lowest for never smokers with no passive smoke exposure (11.5%). Current smokers (hazard ratio 1.65, 95% confidence interval 1.27 to 2.13) and never smokers with passive smoke exposure (1.35, 1.06 to 1.71) remained at higher risk than never smokers without passive smoke exposure after adjustment for multiple baseline sociodemographic, biological, and behavioural factors, but risk in previous smokers was similar to that in never smokers without passive smoke exposure.
These findings support a role of both active and passive smoking in the development of glucose intolerance in young adulthood.
评估主动吸烟者和被动吸烟者相比不吸烟者发生临床相关糖耐量异常或糖尿病的可能性是否更高。
青年成人冠心病风险发展研究（CARDIA）是一项始于1985 - 1986年的前瞻性队列研究，随访15年。
研究对象招募自美国阿拉巴马州伯明翰、伊利诺伊州芝加哥、明尼苏达州明尼阿波利斯和加利福尼亚州奥克兰。
18 - 30岁基线时无糖耐量异常的黑人和白人男性及女性，包括1386名当前吸烟者、621名既往吸烟者、1452名报告有二手烟暴露（通过血清可替宁浓度1 - 15 ng/ml证实）的从不吸烟者以及1113名无二手烟暴露的从不吸烟者。
随访15年期间发生糖耐量异常（血糖≥100 mg/dl或正在服用抗糖尿病药物）的时间。
基线时的中位年龄为25岁，55%的参与者为女性，50%为非裔美国人。随访期间，16.7%的参与者发生了糖耐量异常。吸烟暴露与糖耐量异常的发生之间存在分级关联。糖耐量异常的15年发病率在吸烟者中最高（21.8%），其次是有被动吸烟暴露的从不吸烟者（17.2%），然后是既往吸烟者（14.4%）；在无被动吸烟暴露的从不吸烟者中最低（11.5%）。在对多个基线社会人口统计学、生物学和行为因素进行调整后，当前吸烟者（风险比1.65，95%置信区间1.27至2.13）和有被动吸烟暴露的从不吸烟者（1.35，1.06至1.71）仍比无被动吸烟暴露的从不吸烟者风险更高，但既往吸烟者的风险与无被动吸烟暴露的从不吸烟者相似。
这些发现支持主动吸烟和被动吸烟在青年期糖耐量异常发生过程中均起作用。
