戒烟后体重增加并不会改变其对心肌梗死和中风的保护作用：来自一项男性队列研究的证据。
Weight gain after smoking cessation does not modify its protective effect on myocardial infarction and stroke: evidence from a cohort study of men.
机构信息
Department of Biomedical Sciences, Seoul National University Graduate School, Biomedical Science Building 117, 103 Daehak-ro, Jongro-gu, Seoul, Republic of Korea 03080.
Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul, Republic of Korea 03080.
出版信息
Eur Heart J. 2018 May 1;39(17):1523-1531. doi: 10.1093/eurheartj/ehx761.
AIMS
This study aimed to investigate the association between smoking cessation, post-cessation body mass index (BMI) change and risk of myocardial infarction (MI) and stroke in men.
METHODS AND RESULTS
A prospective cohort study using the National Health Insurance Service (NHIS) data set collected from 2002 to 2013 was implemented. Based on the first (2002-03) and second (2004-05) NHIS health check-up periods, 108 242 men aged over 40 years without previous diagnoses of MI or stroke were grouped into sustained smokers, quitters with BMI gain, quitters without BMI change, quitters with BMI loss, and non-smokers. Body mass index change was defined as the difference of more than 1.0 kg/m2 between the two health check-up periods. The participants were followed-up from 1 January 2006 to 31 December 2013. Hazard ratios (HRs) and 95% confidence intervals (HR, 95% CI) were computed using Cox proportional hazard models adjusted for sociodemographic, health status, and family health history. Compared to the sustained smokers, the risk of MI and stroke was significantly reduced in both quitters with BMI gain (HR 0.33; 95% CI 0.16-0.70 for MI and HR 0.75; 95% CI 0.57-1.00 for stroke) and without BMI change (HR 0.55; 95% CI 0.37-0.83 for MI and HR 0.75; 95% CI 0.62-0.92 for stroke), but no significant association was found in quitters with BMI loss (HR 0.91; 95% CI 0.43-1.91 for MI and HR 0.86; 95% CI 0.57-1.31 for stroke), respectively. Non-smokers had lower risk of MI (HR 0.37; 95% CI 0.32-0.43) and stroke (HR 0.68; 95% CI 0.64-0.73) compared to the sustained smokers.
CONCLUSION
Post-cessation BMI change did not significantly modify the protective association of smoking cessation with MI and stroke.
目的
本研究旨在探讨男性戒烟、戒烟后体重指数（BMI）变化与心肌梗死（MI）和中风风险之间的关系。
方法和结果
本研究采用国家健康保险服务（NHIS）数据进行前瞻性队列研究，数据收集时间为 2002 年至 2013 年。根据 NHIS 健康检查的第一（2002-03 年）和第二（2004-05 年）期，将 108242 名年龄在 40 岁以上、无既往 MI 或中风诊断的男性分为持续吸烟者、BMI 增加的戒烟者、BMI 无变化的戒烟者、BMI 下降的戒烟者和不吸烟者。BMI 变化定义为两次健康检查期间 BMI 差值大于 1.0kg/m2。从 2006 年 1 月 1 日至 2013 年 12 月 31 日对参与者进行随访。使用 Cox 比例风险模型计算危险比（HR）和 95%置信区间（HR，95%CI），并进行社会人口统计学、健康状况和家族健康史调整。与持续吸烟者相比，BMI 增加（MI：HR 0.33；95%CI 0.16-0.70；中风：HR 0.75；95%CI 0.57-1.00）和 BMI 无变化（MI：HR 0.55；95%CI 0.37-0.83；中风：HR 0.75；95%CI 0.62-0.92）的戒烟者 MI 和中风风险显著降低，但 BMI 下降的戒烟者（MI：HR 0.91；95%CI 0.43-1.91；中风：HR 0.86；95%CI 0.57-1.31）则无显著关联。与持续吸烟者相比，不吸烟者的 MI（HR 0.37；95%CI 0.32-0.43）和中风（HR 0.68；95%CI 0.64-0.73）风险较低。
结论
戒烟后 BMI 变化并不能显著改变戒烟与 MI 和中风之间的保护关联。
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