Gupta Rajeev, Gupta Nishant, Khedar R S
Department of Medicine, Fortis Escorts Hospital, JLN Marg, Jaipur 302017, India.
Indian Heart J. 2013 Jul-Aug;65(4):369-77. doi: 10.1016/j.ihj.2013.06.005. Epub 2013 Jul 16.
Smoking is an important cardiovascular risk factor, however, use of smokeless tobacco has not been well studied. Smokeless tobacco use is high in countries of South and Southeast Asia, Africa and Northern Europe. Meta-analyses of prospective studies of smokeless tobacco users in Europe reported a relative risk for fatal coronary heart disease of 1.13 (confidence intervals 1.06-1.21) and fatal stroke of 1.40 (1.28-1.54) while in Asian countries it was 1.26 (1.12-1.40). Case-control studies reported significantly greater risk for acute coronary events in smokeless tobacco users (odds ratio 2.23, 1.41-3.52), which was lower than smokers (2.89, 2.11-3.96), and subjects who both chewed and smoked, had the greatest risk (4.09, 2.98-5.61). There is a greater prevalence of hypertension and metabolic syndrome in users of smokeless tobacco. Smokeless tobacco use leads to accelerated atherothrombosis similar to smoking. There is an urgent need for public health and clinical interventions to reduce smokeless tobacco addiction.
吸烟是一个重要的心血管危险因素，然而，无烟烟草的使用尚未得到充分研究。南亚、东南亚、非洲和北欧国家的无烟烟草使用率较高。对欧洲无烟烟草使用者前瞻性研究的荟萃分析报告，致命性冠心病的相对风险为1.13（置信区间1.06 - 1.21），致命性中风的相对风险为1.40（1.28 - 1.54），而在亚洲国家分别为1.26（1.12 - 1.40）。病例对照研究报告，无烟烟草使用者发生急性冠脉事件的风险显著更高（比值比2.23，1.41 - 3.52），低于吸烟者（2.89，2.11 - 3.96），而既咀嚼又吸烟的受试者风险最大（4.09，2.98 - 5.61）。无烟烟草使用者中高血压和代谢综合征的患病率更高。使用无烟烟草会导致类似于吸烟的动脉粥样硬化血栓形成加速。迫切需要公共卫生和临床干预措施来减少无烟烟草成瘾。
