在英国1937360人中，吸烟与心血管疾病多种初始表现之间的异质性关联：终生风险及对风险预测的影响
Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.
作者信息
Pujades-Rodriguez Mar, George Julie, Shah Anoop Dinesh, Rapsomaniki Eleni, Denaxas Spiros, West Robert, Smeeth Liam, Timmis Adam, Hemingway Harry
机构信息
Farr Institute of Health Informatics Research, University College London, London, UK, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK and National Institute for Health Research, Biomedical Research Unit, Barts Health NHS Trust, London, UK
Farr Institute of Health Informatics Research, University College London, London, UK, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK and National Institute for Health Research, Biomedical Research Unit, Barts Health NHS Trust, London, UK.
出版信息
Int J Epidemiol. 2015 Feb;44(1):129-41. doi: 10.1093/ije/dyu218. Epub 2014 Nov 20.
BACKGROUND
It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation.
METHODS
Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997-2010. Individuals were drawn from linked electronic health records in England, covering primary care, hospitalizations, myocardial infarction (MI) registry and cause-specific mortality (the CALIBER programme).
RESULTS
During 11.6 million person-years of follow-up, 114859 people had an initial non-fatal or fatal CVD presentation. By age 90 years, current vs never smokers' lifetime risks varied from 0.4% vs 0.2% for subarachnoid haemorrhage (SAH), to 8.9% vs 2.6% for peripheral arterial disease (PAD). Current smoking showed no association with cardiac arrest or sudden cardiac death [hazard ratio (HR)=1.04, 95% confidence interval (CI) 0.91-1.19).The strength of association differed markedly according to disease type: stable angina (HR=1.08, 95% CI 1.01-1.15),transient ischaemic attack (HR=1.41, 95% CI 1.28-1.55), unstable angina (HR=1.54, 95% CI 1.38-1.72), intracerebral haemorrhage (HR=1.61, 95% CI 1.37-1.89), heart failure (HR=1.62, 95% CI 1.47-1.79), ischaemic stroke (HR=1.90, 95% CI 1.72-2.10), MI (HR=2.32, 95% CI 2.20-2.45), SAH (HR= 2.70, 95% CI 2.27-3.21), PAD (HR=5.16, 95% CI 4.80-5.54) and abdominal aortic aneurysm (AAA) (HR=5.18, 95% CI 4.61-5.82). Population-attributable fractions were lower for women than men for unheralded coronary death, ischaemic stroke, PAD and AAA. Ten years after quitting smoking, the risks of PAD, AAA (in men) and unheralded coronary death remained increased (HR=1.36, 1.47 and 2.74, respectively).
CONCLUSIONS
The heterogeneous associations of smoking with different CVD presentations suggests different underlying mechanisms and have important implications for research, clinical screening and risk prediction.
背景
目前尚不清楚吸烟如何影响各种急慢性心血管疾病（CVD）的初始表现，也不清楚关联的异质性程度。我们估计了12种心血管疾病表现的终生累积发病率，并研究了与吸烟及戒烟的关联。
方法
对1997年至2010年间193万年龄≥30岁且无心血管疾病史的人群进行队列研究。个体数据来自英国关联的电子健康记录，涵盖初级保健、住院治疗、心肌梗死（MI）登记和特定病因死亡率（CALIBER项目）。
结果
在1160万人年的随访期间，114859人首次出现非致命性或致命性心血管疾病。到90岁时，当前吸烟者与从不吸烟者相比，蛛网膜下腔出血（SAH）的终生风险分别为0.4%和0.2%，外周动脉疾病（PAD）为8.9%和2.6%。当前吸烟与心脏骤停或心源性猝死无关联[风险比（HR）=1.04，95%置信区间（CI）0.91 - 1.19]。关联强度因疾病类型而异：稳定型心绞痛（HR = 1.08，95% CI 1.01 - 1.15）、短暂性脑缺血发作（HR = 1.41，95% CI 1.28 - 1.55）、不稳定型心绞痛（HR = 1.54，95% CI 1.38 - 1.72）、脑出血（HR = 1.61，95% CI 1.37 - 1.89）、心力衰竭（HR = 1.62，95% CI 1.47 - 1.79）、缺血性卒中（HR = 1.90，95% CI 1.72 - 2.10）、心肌梗死（HR = 2.32，95% CI 2.20 - 2.45）、蛛网膜下腔出血（HR = 2.70，95% CI 2.27 - 3.21）、外周动脉疾病（HR = 5.16，95% CI 4.80 - 5.54）和腹主动脉瘤（AAA）（HR = 5.18，95% CI 4.61 - 5.82）。未被发现的冠心病死亡、缺血性卒中、外周动脉疾病和腹主动脉瘤的人群归因分数女性低于男性。戒烟十年后，外周动脉疾病、腹主动脉瘤（男性）和未被发现的冠心病死亡风险仍升高（HR分别为1.36、1.47和2.74）。
结论
吸烟与不同心血管疾病表现的异质性关联提示存在不同的潜在机制，对研究、临床筛查和风险预测具有重要意义。
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