Leviev Heart Institute, Sheba Medical Centre, Israel.
Department of Internal Medicine C, Sheba Medical Centre, Israel Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Centre, Israel Sackler School of Medicine, Tel-Aviv University, Israel.
Eur J Prev Cardiol. 2015 Jun;22(6):807-14. doi: 10.1177/2047487314535116. Epub 2014 May 9.
Smoking is an independent cardiovascular risk factor and correlates with reduced exercise tolerance. However, data on the time dependent effect of smoking cessation on exercise tolerance are limited.
We investigated 17,115 men and women who were annually screened at the Institute for Medical Screening of the Chaim Sheba Medical Centre. All subjects had their smoking status documented and performed an exercise stress testing (EST) according to Bruce protocol at each visit. Subjects were divided at baseline into four groups: active smokers (N = 2858), recent quitters (smoking cessation ≤2 years before baseline EST; N = 861), remote quitters (smoking cessation >2 years before the baseline EST; N = 3856) and never smokers (N = 9810). Baseline and follow up EST duration were compared among the four groups.
Recent quitters demonstrated a 2.4-fold improvement in their EST duration compared with active smokers (improvement of 24 ± 157 vs. 10 ± 157 s, respectively, p = 0.02). Multivariate logistic regression showed that recent quitters were 26% more likely to improve their exercise tolerance compared with active smokers (95% confidence interval (CI) 1.08-1.47, p = 0.003). Assessing smoking status as a time-dependent covariate during four consecutive visits demonstrated that recent quitters were 17% more likely to improve their exercise tolerance compared with active smokers (95% CI 1.02-1.34, p = 0.02), with a less pronounced benefit among remote quitters (hazard ratio = 1.11, 95% CI 1.02-1.21; p = 0.01).
Smoking cessation is independently associated with improved exercise tolerance. The benefits of smoking cessation are evident within the first two years of abstinence.
吸烟是一个独立的心血管危险因素，与运动耐量降低相关。然而，关于戒烟对运动耐量的时间依赖性影响的数据有限。
我们调查了在 Chaim Sheba 医疗中心医学筛查研究所每年接受筛查的 17115 名男性和女性。所有受试者的吸烟状况均有记录，并在每次就诊时根据 Bruce 方案进行运动应激测试（EST）。受试者在基线时分为四组：主动吸烟者（N=2858）、近期戒烟者（戒烟≤基线 EST 前 2 年；N=861）、长期戒烟者（戒烟>基线 EST 前 2 年；N=3856）和从不吸烟者（N=9810）。比较四组的基线和随访 EST 持续时间。
与主动吸烟者相比，近期戒烟者的 EST 持续时间提高了 2.4 倍（分别为改善 24±157 秒和 10±157 秒，p=0.02）。多变量逻辑回归显示，与主动吸烟者相比，近期戒烟者改善运动耐量的可能性高 26%（95%置信区间[CI]1.08-1.47，p=0.003）。在连续四次就诊中，将吸烟状况作为一个时间依赖性协变量进行评估表明，与主动吸烟者相比，近期戒烟者改善运动耐量的可能性高 17%（95%CI1.02-1.34，p=0.02），而长期戒烟者的获益较小（风险比=1.11，95%CI1.02-1.21；p=0.01）。
戒烟与运动耐量的改善独立相关。戒烟的益处在戒烟后的头两年内即可显现。
