Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Am J Med. 2017 Sep;130(9):1084-1091. doi: 10.1016/j.amjmed.2017.02.052. Epub 2017 Apr 8.
We evaluated long-term incidence of cancer after myocardial infarction among current, former, and never smokers, and assessed whether reducing cigarette consumption is associated with decreased cancer risk.
Consecutive patients aged ≤65 years discharged from 8 hospitals in central Israel after first myocardial infarction in 1992-1993 were followed for cancer and death. Extensive data including smoking habits were obtained at the index hospitalization and 4 time points during follow-up. Survival methods were applied to assess the hazard ratios (HRs) for cancer associated with smoking categories.
Included in the study were 1486 cancer-free participants (mean age, 54 years; 81% men), among whom 787 were current smokers at baseline (average daily cigarette consumption = 29). Smokers were younger than nonsmokers and more likely to be male and of lower socioeconomic status. Over a median follow-up of 21.4 years, 273 (18.4%) patients developed cancer. Baseline smoking was associated with a ∼40% excess adjusted risk of cancer; ∼25% after accounting for death as a competing event. Considering changes in smoking during follow-up, the excess risk was confined to persistent smokers (adjusted HR 1.75; 95% confidence interval [CI], 1.22-2.50), whereas post- (HR 1.14; 95% CI, 0.80-1.62) and pre-myocardial infarction quitters (HR 1.02; 95% CI, 0.71-1.47) were comparable with never smokers. Among persistent smokers, each reduction of 10 cigarettes relative to pre-myocardial infarction consumption was associated with a ∼10% reduced adjusted risk.
Among young survivors of first myocardial infarction followed-up longitudinally, smoking cessation is associated with lower risk of cancer. Reducing consumption among smokers may also be beneficial.
我们评估了当前、曾经和从不吸烟者心肌梗死后的癌症长期发病率，并评估了减少吸烟量是否与降低癌症风险有关。
1992-1993 年以色列中部 8 家医院收治的首次心肌梗死后年龄≤65 岁的连续患者在随访期间发生癌症和死亡。在指数住院期间和随访的 4 个时间点获得了包括吸烟习惯在内的广泛数据。生存方法用于评估与吸烟类别相关的癌症风险的危害比（HR）。
研究包括 1486 名无癌症参与者（平均年龄 54 岁，81%为男性），其中 787 名参与者在基线时为当前吸烟者（平均每日吸烟量为 29 支）。吸烟者比非吸烟者年轻，更有可能是男性和社会经济地位较低。在中位随访 21.4 年后，273 名（18.4%）患者发生癌症。基线吸烟与癌症调整后风险增加约 40%相关；考虑到竞争事件死亡后，风险增加约 25%。考虑到随访期间吸烟习惯的变化，这种额外风险仅限于持续吸烟者（调整后的 HR 1.75；95%置信区间 [CI]，1.22-2.50），而心肌梗死后戒烟者（HR 1.14；95% CI，0.80-1.62）和心肌梗死后戒烟者（HR 1.02；95% CI，0.71-1.47）与从不吸烟者相当。在持续吸烟者中，与心肌梗死后吸烟量相比，每次减少 10 支烟与调整后风险降低约 10%相关。
在接受长期纵向随访的首次心肌梗死后年轻幸存者中，戒烟与癌症风险降低相关。减少吸烟者的吸烟量也可能有益。
