Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
Eur J Epidemiol. 2013 Aug;28(8):649-58. doi: 10.1007/s10654-013-9776-0. Epub 2013 Feb 9.
Smoking is an established risk factor for cardiovascular events, such as myocardial infarction, stroke and cardiovascular death. However, most pertinent studies primarily relied on middle aged adults. We aimed to provide empirical evidence on the association of smoking with cardiovascular events and the benefits of smoking cessation in people aged 50 years or older. In a German population-based cohort study detailed information on lifetime smoking history was obtained from 8,807 individuals aged 50-74 years, without previous myocardial infarction (MI) or stroke. Cox proportional hazards regression was applied to estimate the impact of smoking on MI, stroke and cardiovascular death (CVD) as well as on the combined outcome of major cardiovascular events (MI, stroke or CVD). In addition, the impact of smoking and the benefits of smoking cessation were quantified by risk advancement periods (RAP). The cohort included 17.2 % current smokers, 31.7 % former smokers and 51.1 % never smokers. During a mean follow-up of 9.1 years, 261 participants experienced a first MI, 456 had a primary stroke and 274 died of cardiovascular reasons. Compared to never smokers, adjusted hazard ratios (95 % confidence intervals) of current smokers were 2.25 (1.62-3.12), 2.12 (1.65-2.73) and 2.45 (1.76-3.42) and RAPs were 19.3, 9.8 and 8.4 years for MI, stroke and CVD, respectively. Strong dose-response relationships were seen with both current and life-time amount of smoking. Most of the excess risk and risk advancement disappeared within 5 years after smoking cessation. Smoking is a strong risk factor for cardiovascular events even at older age. Smoking cessation is highly and rapidly beneficial also at advanced age.
吸烟是心血管事件（如心肌梗死、中风和心血管死亡）的既定危险因素。然而，大多数相关研究主要依赖于中年成年人。我们旨在提供关于 50 岁或以上人群吸烟与心血管事件的关联以及戒烟益处的经验证据。在一项基于德国人群的队列研究中，从 8807 名年龄在 50-74 岁、无既往心肌梗死（MI）或中风的个体中详细获取了终生吸烟史的信息。应用 Cox 比例风险回归来估计吸烟对 MI、中风和心血管死亡（CVD）的影响，以及主要心血管事件（MI、中风或 CVD）的联合结局。此外，还通过风险提前期（RAP）量化了吸烟的影响和戒烟的益处。该队列包括 17.2%的当前吸烟者、31.7%的前吸烟者和 51.1%的从不吸烟者。在平均 9.1 年的随访期间，261 名参与者发生首次 MI，456 名发生原发性中风，274 名死于心血管原因。与从不吸烟者相比，当前吸烟者的调整后的危险比（95%置信区间）分别为 2.25（1.62-3.12）、2.12（1.65-2.73）和 2.45（1.76-3.42），RAP 分别为 19.3、9.8 和 8.4 年，用于 MI、中风和 CVD。当前和终生吸烟量均与强烈的剂量反应关系有关。大多数过量风险和风险提前消失在戒烟后 5 年内。吸烟是心血管事件的一个强有力的危险因素，即使在老年也是如此。戒烟在高龄时也具有高度和快速的益处。
