Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
JACC Cardiovasc Imaging. 2013 Jun;6(6):651-7. doi: 10.1016/j.jcmg.2013.02.004. Epub 2013 Mar 13.
The aim of this study was to assess the relationship of the extent of subclinical atherosclerosis measured by coronary artery calcification (CAC) to the extent of second-hand tobacco smoke (SHTS) exposure in asymptomatic people who never smoked.
An association between SHTS and CAC was recently reported in a single study, but the quantitative aspects of the relationship are not known.
A cohort of 3,098 never smokers 40 to 80 years of age, enrolled in the FAMRI-IELCAP (Flight Attendant Medical Research Institute International Early Lung Cancer Action Program) screening program, completed a SHTS questionnaire, and had a low-dose nongated computed tomography scan. The questionnaire provided a quantitative score for total SHTS exposure, as well as separately as a child and as an adult at home and at work; 4 categories of exposure to SHTS were identified (minimal, low, moderate, and high exposure). CAC was graded using a previously validated ordinal scale score that ranged from 0 to 12. Logistic regression analysis of the prevalence and ordered logistic regression analysis of the extent of CAC were performed to assess the independent contribution of SHTS adjusted for age, sex, diabetes, hypercholesterolemia, hypertension, and renal disease. Linear and quadratic regression analyses of CAC and SHTS were performed.
The prevalence of CAC was 24.3% (n = 754) and was significantly higher in those with more than minimal SHTS exposure compared with those with minimal SHTS exposure (26.4% vs. 18.5%, p < 0.0001). The adjusted odds ratios for CAC prevalence were 1.54 (95% confidence interval: 1.17 to 2.20) for low SHTS exposure, 1.60 (95% confidence interval: 1.21 to 2.10) for moderate exposure, and 1.93 (95% confidence interval: 1.49 to 2.51) for high exposure. The association of the extent of SHTS with the extent of CAC was confirmed by the adjusted odds ratio (p < 0.0001).
The presence and extent of CAC were associated with extent of SHTS exposure even when adjusted for other risk factors for CAC, suggesting that SHTS exposure causes CAC.
本研究旨在评估通过冠状动脉钙化（CAC）测量的亚临床动脉粥样硬化程度与从不吸烟的无症状人群中二手烟暴露（SHTS）程度之间的关系。
最近的一项研究报告了 SHTS 与 CAC 之间的关联，但两者之间关系的定量方面尚不清楚。
一项由 3098 名年龄在 40 至 80 岁之间的从不吸烟者组成的队列参加了飞行人员医学研究协会国际早期肺癌行动计划（FAMRI-IELCAP）筛查计划，完成了一份 SHTS 调查问卷，并进行了低剂量非门控计算机断层扫描。该问卷提供了总 SHTS 暴露的定量评分，以及作为儿童和在家中和工作时的成人分别的评分；确定了 SHTS 暴露的 4 个类别（最低、低、中、高暴露）。CAC 使用先前验证的有序量表评分进行分级，范围为 0 至 12 分。进行了 CAC 患病率的 logistic 回归分析和 CAC 程度的有序 logistic 回归分析，以评估 SHTS 调整年龄、性别、糖尿病、高胆固醇血症、高血压和肾脏疾病后的独立贡献。进行了 CAC 和 SHTS 的线性和二次回归分析。
CAC 的患病率为 24.3%（n=754），与最低 SHTS 暴露相比，暴露于超过最低 SHTS 的患者的患病率明显更高（26.4% vs. 18.5%，p<0.0001）。CAC 患病率的调整比值比为低 SHTS 暴露 1.54（95%置信区间：1.17 至 2.20），中度暴露 1.60（95%置信区间：1.21 至 2.10），高暴露 1.93（95%置信区间：1.49 至 2.51）。调整后的比值比证实了 SHTS 暴露程度与 CAC 程度之间的关联（p<0.0001）。
即使在调整 CAC 的其他危险因素后，CAC 的存在和程度也与 SHTS 暴露程度相关，表明 SHTS 暴露会导致 CAC。
