Units of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Br J Surg. 2014 Sep;101(10):1230-7. doi: 10.1002/bjs.9526. Epub 2014 Jun 11.
It is unclear whether recommendations about ultrasound screening programmes for abdominal aortic aneurysm (AAA) among men should be extended to include women who smoke. The aim was to examine sex-specific dose-response associations between AAA risk and smoking status, pack-years smoked and time since smoking cessation.
Women in the Swedish Mammography Cohort and men in the Cohort of Swedish Men were followed up from 1998 to 2011. AAA was identified through linkage of the cohorts to the Swedish Inpatient Register and the Swedish National Register for Vascular Surgery (Swedvasc), and not through general ultrasound screening. Associations were estimated with Cox proportional hazards models.
The cohorts included 35 550 women and 42 596 men, aged 46-84 years. During follow-up, AAA was identified in 199 women and 958 men. The incidence of AAA per 100 000 person-years was 76 among men who never smoked and 136 among women who currently smoke. Regarding AAA risk, women were more sensitive to current smoking (Pinteraction = 0·002). Compared with never smokers, the hazard ratio (HR) for AAA in current smokers with more than 20 pack-years was 10·97 (95 per cent confidence interval 7·41 to 16·26) among women and 6·55 (5·36 to 7·99) among men. Following smoking cessation, women had a more rapid decline in excess risk (Pinteraction < 0·001). The risk was halved after 11 years (HR 0·51, 0·32 to 0·81) among women and after 23 years (HR 0·50, 0·42 to 0·60) among men.
There were sex differences in the associations between smoking status and AAA risk. These data support further investigation of targeted AAA screening among women who smoke.
目前尚不清楚是否应将男性腹主动脉瘤（AAA）超声筛查计划的建议扩展到吸烟的女性。本研究旨在探讨 AAA 风险与吸烟状况、吸烟量和戒烟时间之间的性别特异性剂量-反应关系。
对瑞典乳腺队列中的女性和瑞典男性队列中的男性进行了随访，随访时间为 1998 年至 2011 年。通过队列与瑞典住院患者登记处和瑞典血管外科登记处（Swedvasc）的链接来识别 AAA，而不是通过一般的超声筛查。使用 Cox 比例风险模型估计关联。
队列纳入了 35550 名女性和 42596 名男性，年龄 46-84 岁。随访期间，199 名女性和 958 名男性被诊断为 AAA。每 100000 人年的 AAA 发生率为男性从不吸烟者的 76 例和女性当前吸烟者的 136 例。关于 AAA 风险，女性对当前吸烟更敏感（P 交互作用=0·002）。与从不吸烟者相比，当前吸烟者中吸烟量超过 20 包年的女性发生 AAA 的危险比（HR）为 10.97（95%置信区间 7.41-16.26），男性为 6.55（5.36-7.99）。戒烟后，女性的超额风险下降速度更快（P 交互作用<0·001）。女性风险在 11 年后减半（HR 0·51，0·32-0·81），男性在 23 年后减半（HR 0·50，0·42-0·60）。
吸烟状况与 AAA 风险之间的关联存在性别差异。这些数据支持进一步研究针对吸烟女性的靶向 AAA 筛查。
