Rusanen Minna, Kivipelto Miia, Quesenberry Charles P, Zhou Jufen, Whitmer Rachel A
Department of Neurology, University of Eastern Finland, Kuopio, Finland.
Arch Intern Med. 2011 Feb 28;171(4):333-9. doi: 10.1001/archinternmed.2010.393. Epub 2010 Oct 25.
Smoking is a risk factor for several life-threatening diseases, but its long-term association with dementia is controversial and somewhat understudied. Our objective was to investigate the long-term association of amount of smoking in middle age on the risk of dementia, Alzheimer disease (AD), and vascular dementia (VaD) several decades later in a large, diverse population.
We analyzed prospective data from a multiethnic population-based cohort of 21,123 members of a health care system who participated in a survey between 1978 and 1985. Diagnoses of dementia, AD, and VaD made in internal medicine, neurology, and neuropsychology were collected from January 1, 1994, to July 31, 2008. Multivariate Cox proportional hazards models were used to investigate the association between midlife smoking and risk of dementia, AD, and VaD.
A total of 5367 people (25.4%) were diagnosed as having dementia (including 1136 cases of AD and 416 cases of VaD) during a mean follow-up period of 23 years. Results were adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use. Compared with nonsmokers, those smoking more than 2 packs a day had an elevated risk of dementia (adjusted hazard ratio [HR], 2.14; 95% CI, 1.65-2.78), AD (adjusted HR, 2.57; 95% CI, 1.63-4.03), and VaD (adjusted HR, 2.72; 95% CI, 1.20-6.18).
In this large cohort, heavy smoking in midlife was associated with a greater than 100% increase in risk of dementia, AD, and VaD more than 2 decades later. These results suggest that the brain is not immune to long-term consequences of heavy smoking.
吸烟是多种危及生命疾病的危险因素，但其与痴呆症的长期关联存在争议且研究较少。我们的目的是在一个大型多样化人群中，研究中年吸烟量与数十年后痴呆症、阿尔茨海默病（AD）和血管性痴呆（VaD）风险的长期关联。
我们分析了来自一个基于多民族人群的队列的前瞻性数据，该队列由21123名医疗系统成员组成，他们在1978年至1985年期间参与了一项调查。1994年1月1日至2008年7月31日期间收集了内科、神经科和神经心理学做出的痴呆症、AD和VaD诊断。使用多变量Cox比例风险模型研究中年吸烟与痴呆症、AD和VaD风险之间的关联。
在平均23年的随访期内，共有5367人（25.4%）被诊断患有痴呆症（包括1136例AD和416例VaD）。结果针对年龄、性别、教育程度、种族、婚姻状况、高血压、高脂血症、体重指数、糖尿病、心脏病、中风和饮酒情况进行了调整。与不吸烟者相比，每天吸烟超过2包的人患痴呆症（调整后的风险比[HR]，2.14；95%置信区间[CI]，1.65 - 2.78）、AD（调整后的HR，2.57；95%CI，1.63 - 4.03）和VaD（调整后的HR，2.72；95%CI，1.20 - 6.18）的风险升高。
在这个大型队列中，中年大量吸烟与二十多年后患痴呆症、AD和VaD的风险增加超过100%有关。这些结果表明，大脑无法免受大量吸烟的长期影响。
