Fonarow Gregg C, Abraham William T, Albert Nancy M, Stough Wendy Gattis, Gheorghiade Mihai, Greenberg Barry H, O'Connor Christopher M, Nunez Eduardo, Yancy Clyde W, Young James B
Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA.
Eur Heart J. 2008 Aug;29(16):1983-91. doi: 10.1093/eurheartj/ehn210. Epub 2008 May 15.
Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studies have shown lower mortality after acute coronary syndromes in smokers compared with non-smokers, the so called 'smoker's paradox'. This study aimed to ascertain the relationship between smoking and clinical outcomes in patients hospitalized with heart failure (HF).
OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) collected data on 48 612 patients from 259 hospitals. Characteristics, treatments, and outcomes were compared for current/recent smokers vs. those without current/recent smoking, and multivariable regression analyses with adjustment for hospital clustering were performed. There were 7743 (15.9%) smokers, 39 126 (80.5%) non-smokers, and 1743 (3.6%) missing. Smokers were younger, had similar renal function, but lower ejection fraction. The risk of in-hospital mortality was less in smokers (2.3 vs. 3.9%, P < 0.001). After extensive covariate adjustment, smokers still had lower in-hospital mortality risk OR (odds ratio) 0.70, 95% CI (confidence interval) 0.56-0.88, P = 0.002. Post-discharge, smokers (n = 998) had similar mortality risk (6.7 vs. 8.4%, P = 0.29) compared with those without current/recent smoking.
Smokers hospitalized with HF had lower risk adjusted in-hospital mortality and similar early post-discharge mortality compared with non-smokers. The residual association of smoking and better prognosis, the 'smoker's paradox', was not fully explained by measured covariates.
吸烟是心血管疾病公认的危险因素，但多项研究表明，与不吸烟者相比，急性冠脉综合征患者中吸烟者的死亡率更低，即所谓的“吸烟者悖论”。本研究旨在确定心力衰竭（HF）住院患者吸烟与临床结局之间的关系。
优化心力衰竭治疗（OPTIMIZE-HF，住院心力衰竭患者启动挽救生命治疗的组织项目）收集了来自259家医院的48612例患者的数据。比较了当前/近期吸烟者与非当前/近期吸烟者的特征、治疗和结局，并进行了多变量回归分析以调整医院聚类情况。有7743例（15.9%）吸烟者，39126例（80.5%）非吸烟者，1743例（3.6%）缺失数据。吸烟者更年轻，肾功能相似，但射血分数较低。吸烟者住院死亡率较低（2.3%对3.9%，P<0.001）。经过广泛的协变量调整后，吸烟者的住院死亡风险仍然较低，比值比（OR）为0.70，95%置信区间（CI）为0.56-0.88，P=0.002。出院后，吸烟者（n=998）与非当前/近期吸烟者相比，死亡风险相似（6.7%对8.4%，P=0.29）。
与非吸烟者相比，因心力衰竭住院的吸烟者经风险调整后的住院死亡率较低，出院后早期死亡率相似。吸烟与较好预后之间的残余关联，即“吸烟者悖论”，并未完全由测量的协变量解释。
