Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
PLoS One. 2013 Jun 20;8(6):e66484. doi: 10.1371/journal.pone.0066484. Print 2013.
Current smokers have an increased cardiovascular disease (CVD) risk compared to ex-smokers due to reversible as well as irreversible effects of smoking. We investigated if current smokers remain to have an increased CVD risk compared to ex-smokers in subjects with a long and intense smoking history. We in addition studied if the effect of smoking continuation on CVD risk is independent of or modified by the presence of cardiovascular calcifications.
The cohort used comprised a sample of 3559 male lung cancer screening trial participants. We conducted a case-cohort study using all CVD cases and a random sample of 10% (n = 341) from the baseline cohort (subcohort). A weighted Cox proportional hazards model was used to estimate the hazard ratios for current smoking status in relation to CVD events.
During a median follow-up of 2.6 years (max. 3.7 years), 263 fatal and non-fatal cardiovascular events (cases) were identified. Age, packyears and cardiovascular calcification adjusted hazard ratio of current smokers compared to former smokers was 1.33 (95% confidence interval 1.00-1.77). In additional analyses that incorporated multiplicative interaction terms, neither coronary nor aortic calcifications modified the association between smoking status and cardiovascular risk (P = 0.08).
Current smokers have an increased CVD risk compared to former smokers even in subjects with a long and intense smoking history. Smoking exerts its hazardous effects on CVD risk by pathways partly independent of cardiovascular calcifications.
与戒烟者相比，当前吸烟者由于吸烟的可逆转和不可逆转的影响，心血管疾病（CVD）的风险增加。我们研究了在有长期和强烈吸烟史的人群中，与戒烟者相比，当前吸烟者是否仍然存在更高的 CVD 风险。我们还研究了吸烟持续对 CVD 风险的影响是否独立于或受心血管钙化的存在影响。
本研究使用了一个由 3559 名男性肺癌筛查试验参与者组成的队列。我们进行了病例-队列研究，使用了所有 CVD 病例和基线队列（子队列）的随机 10%（n=341）的样本。使用加权 Cox 比例风险模型来估计当前吸烟状态与 CVD 事件的风险比。
在中位数为 2.6 年（最长 3.7 年）的随访期间，确定了 263 例致命和非致命心血管事件（病例）。年龄、吸烟年数和心血管钙化校正后，与戒烟者相比，当前吸烟者的危险比为 1.33（95%置信区间 1.00-1.77）。在纳入乘法交互项的额外分析中，冠状动脉或主动脉钙化均未改变吸烟状态与心血管风险之间的关联（P=0.08）。
与戒烟者相比，即使在有长期和强烈吸烟史的人群中，当前吸烟者的 CVD 风险也会增加。吸烟对 CVD 风险的危害作用部分独立于心血管钙化。
