Cheezum Michael K, Kim Alexander, Bittencourt Marcio S, Kassop David, Nissen Alexander, Thomas Dustin M, Nguyen Binh, Glynn Robert J, Shah Nishant R, Villines Todd C
Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD, USA.
Uniformed Services University of Health Sciences, Bethesda, MD, USA.
Atherosclerosis. 2017 Feb;257:201-207. doi: 10.1016/j.atherosclerosis.2016.11.016. Epub 2016 Nov 16.
The impact of tobacco use and cessation on atherogenesis remains unclear. We aimed to study the association of tobacco use and prior cessation with the presence, extent and severity of atherosclerosis on coronary computed tomographic angiography (CTA).
We examined 1798 consecutive symptomatic patients without known coronary artery disease (CAD) referred for CTA, stratified by smoking status (never, current [within 30 days], or former [>30 days before CTA]). Plaque severity (none, <50%, ≥50% stenosis), composition (non-calcified [NCP], partially calcified [PCP], or calcified plaque [CP]), and segment involvement score (SIS) were visually graded. Multivariate analysis was performed, adjusting for CAD risk factors and cholesterol lowering medication use.
The median age of patients was 50 years [IQR:42-58] (61% male), with 74% never smokers, 12% current smokers, and 14% former smokers (median quit duration = 12 years [IQR:3-26]). Smoking exposure in former versus current smokers was 11 [IQR:5-25] and 10 [IQR:2-20] pack-years, respectively (p = 0.01). Compared to never smokers, current smokers demonstrated an increased odds ratio of all plaque types (adjusted OR: any NCP = 1.55 [95% CI 1.04-2.32], p = 0.03; any PCP = 1.61 [1.10-2.37], p = 0.02; any CP = 1.93 [1.32-2.81], p = 0.001), non-obstructive CAD (aOR = 1.47 [1.04, 2.07], p = 0.03), obstructive CAD (aOR = 1.81 [1.01-3.24], p = 0.047), and SIS > 4 (aOR = 1.60 [1.04-2.46], p = 0.03). Compared to current smoking, prior smoking cessation (≥12 years) was associated with a decreased odds ratio of any NCP (aOR = 0.42 [0.19-0.90], p = 0.03), CP (aOR = 0.43 [0.22-0.84], p = 0.02), and obstructive CAD (aOR = 0.40, [0.15-0.98], p = 0.048).
Current smoking is independently associated with the presence and extent of coronary plaque, and a higher risk of non-obstructive and obstructive CAD compared to never smoking. Prior smoking cessation correlated with improvements in CTA-identified plaque measures.
烟草使用及戒烟对动脉粥样硬化形成的影响仍不明确。我们旨在研究烟草使用及既往戒烟情况与冠状动脉计算机断层扫描血管造影（CTA）所示动脉粥样硬化的存在、范围及严重程度之间的关联。
我们对1798例因CTA检查而前来就诊的、有症状但无已知冠状动脉疾病（CAD）的连续患者进行了检查，根据吸烟状态（从不吸烟、当前吸烟[在30天内]或既往吸烟[CTA检查前>30天]）进行分层。通过视觉对斑块严重程度（无、<50%、≥50%狭窄）、成分（非钙化斑块[NCP]、部分钙化斑块[PCP]或钙化斑块[CP]）以及节段累及评分（SIS）进行分级。进行多变量分析，并对CAD危险因素和使用的降胆固醇药物进行校正。
患者的中位年龄为50岁[四分位间距：42 - 58岁]（61%为男性），其中74%从不吸烟，12%当前吸烟，14%既往吸烟（中位戒烟时长 = 12年[四分位间距：3 - 26年]）。既往吸烟者与当前吸烟者的吸烟暴露量分别为11[四分位间距：5 - 25]包年和10[四分位间距：2 - 20]包年（p = 0.01）。与从不吸烟者相比，当前吸烟者出现所有类型斑块的比值比均升高（校正比值比：任何NCP = 1.55[可信区间95%：1.04 - 2.32]，p = 0.03；任何PCP = 1.61[1.10 - 2.37]，p = 0.02；任何CP = 1.93[1.32 - 2.81]，p = 0.001），非阻塞性CAD（校正比值比 = 1.47[1.04, 2.07]，p = 0.03），阻塞性CAD（校正比值比 = 1.81[1.01 - 3.24]，p = 0.047），以及SIS > 4（校正比值比 = 1.60[1.04 - 2.46]，p = 0.03）。与当前吸烟相比，既往戒烟（≥12年）与任何NCP（校正比值比 = 0.42[0.19 - 0.90]，p = 0.03）、CP（校正比值比 = 0.43[0.22 - 0.84]，p = 0.02）以及阻塞性CAD（校正比值比 = 0.40，[0.15 - 0.98]，p = 0.048）的比值比降低相关。
当前吸烟与冠状动脉斑块的存在及范围独立相关，与从不吸烟相比，非阻塞性和阻塞性CAD的风险更高。既往戒烟与CTA所显示的斑块指标改善相关。
