Translational Health Sciences, Bristol Medical School, Southmead Hospital University of Bristol, United Kingdom
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust University of Bristol, United Kingdom.
J Am Heart Assoc. 2018 May 2;7(10):e008726. doi: 10.1161/JAHA.118.008726.
We aimed to compare the associations of smoking exposure as assessed by self-reports and urine cotinine with cardiovascular disease (CVD) risk and determine the potential utility of cotinine for CVD risk prediction.
Smoking status by self-reports and urine cotinine were assessed at baseline in 4737 participants (mean age, 53 years) of the PREVEND (Prevention of Renal and Vascular End-Stage Disease) prospective study. Participants were classified as never, former, light current (≤10 cigarettes/day), and heavy current smokers (>10 cigarettes/day) according to self-reports and analogous cutoffs for urine cotinine. During a median follow-up of 8.5 years, 296 first CVD events were recorded. Compared with self-reported never smokers, the hazard ratios (95% confidence interval) of CVD for former, light current, and heavy current smokers were 0.86 (0.64-1.17), 1.28 (0.83-1.97), and 1.80 (1.27-2.57) in multivariate analysis. Compared with urine cotinine-assessed never smokers, the corresponding hazard ratios of CVD for urine cotinine-assessed former, light current, and heavy current smokers were 1.70 (1.03-2.81), 1.62 (1.15-2.28), and 1.95 (1.39-2.73) respectively. The C-index change on adding urine cotinine-assessed smoking status to a standard CVD risk prediction model (without self-reported smoking status) was 0.0098 (0.0031-0.0164; =0.004). The corresponding C-index change for self-reported smoking status was 0.0111 (0.0042-0.0179; =0.002).
Smoking status as assessed by self-reports and urine cotinine is associated with CVD risk; however, the nature of the association of urine cotinine with CVD is consistent with a dose-response relationship. The ability of urine cotinine to improve CVD risk assessment is similar to that of self-reported smoking status.
我们旨在比较通过自我报告和尿液可替宁评估的吸烟暴露与心血管疾病 (CVD) 风险的关联，并确定可替宁在 CVD 风险预测中的潜在效用。
在 PREVEND（预防肾脏和血管终末期疾病）前瞻性研究的 4737 名参与者（平均年龄 53 岁）中，基线时评估了吸烟状况通过自我报告和尿液可替宁进行。根据自我报告和尿液可替宁的类似切点，参与者被分类为从不、曾经、轻量（≤10 支/天）和重度（>10 支/天）吸烟者。在中位随访 8.5 年后，记录了 296 例首次 CVD 事件。与自我报告的从不吸烟者相比，曾吸烟者、轻量吸烟者和重度吸烟者的 CVD 风险比（95%置信区间）分别为 0.86（0.64-1.17）、1.28（0.83-1.97）和 1.80（1.27-2.57）在多变量分析中。与尿液可替宁评估的从不吸烟者相比，尿液可替宁评估的曾吸烟者、轻量吸烟者和重度吸烟者的 CVD 风险比分别为 1.70（1.03-2.81）、1.62（1.15-2.28）和 1.95（1.39-2.73）。将尿液可替宁评估的吸烟状况添加到标准 CVD 风险预测模型（不包括自我报告的吸烟状况）中，C 指数的变化为 0.0098（0.0031-0.0164；=0.004）。自我报告的吸烟状况的相应 C 指数变化为 0.0111（0.0042-0.0179；=0.002）。
通过自我报告和尿液可替宁评估的吸烟状况与 CVD 风险相关；然而，尿液可替宁与 CVD 之间的关联性质与剂量反应关系一致。尿液可替宁改善 CVD 风险评估的能力与自我报告的吸烟状况相似。
