Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Am Heart J. 2019 Jul;213:112-122. doi: 10.1016/j.ahj.2019.03.019. Epub 2019 Apr 25.
To quantify the relation between smoking cessation after a first cardiovascular (CV) event and risk of recurrent CV events and mortality.
Data were available from 4,673 patients aged 61 ± 8.7 years, with a recent (≤1 year) first manifestation of arterial disease participating in the SMART-cohort. Cox models were used to quantify the relation between smoking status and risk of recurrent major atherosclerotic cardiovascular events (MACE including stroke, MI and vascular mortality) and mortality. In addition, survival according to smoking status was plotted, taking competing risk of non-vascular mortality into account.
A third of the smokers stopped after their first CV event. During a median of 7.4 (3.7-10.8) years of follow-up, 794 patients died and 692 MACE occurred. Compared to patients who continued to smoke, patients who quit had a lower risk of recurrent MACE (adjusted HR 0.66, 95% CI 0.49-0.88) and all-cause mortality (adjusted HR 0.63, 95% CI 0.48-0.82). Patients who reported smoking cessation on average lived 5 life years longer and recurrent MACE occurred 10 years later. In patients with a first CV event >70 years, cessation of smoking had improved survival which on average was comparable to former or never smokers.
Irrespective of age at first CV event, cessation of smoking after a first CV event is related to a substantial lower risk of recurrent vascular events and all-cause mortality. Since smoking cessation is more effective in reducing CV risk than any pharmaceutical treatment of major risk factors, it should be a key objective for patients with vascular disease.
定量评估首次心血管（CV）事件后戒烟与复发性 CV 事件和死亡率之间的关系。
数据来自 4673 名年龄为 61±8.7 岁、近期（≤1 年）首次出现动脉疾病的 SMART 队列患者。Cox 模型用于量化吸烟状况与复发性主要动脉粥样硬化性心血管事件（包括中风、心肌梗死和血管死亡率的 MACE）和死亡率之间的关系。此外，考虑到非血管性死亡率的竞争风险，根据吸烟状况绘制了生存情况。
三分之一的吸烟者在首次 CV 事件后戒烟。在中位数为 7.4（3.7-10.8）年的随访期间，794 名患者死亡，692 名发生 MACE。与继续吸烟的患者相比，戒烟的患者发生复发性 MACE 的风险较低（调整后的 HR 0.66，95%CI 0.49-0.88）和全因死亡率（调整后的 HR 0.63，95%CI 0.48-0.82）。报告平均戒烟的患者多活了 5 年，且复发性 MACE 发生时间推迟了 10 年。在首次 CV 事件年龄>70 岁的患者中，戒烟改善了生存，平均与曾经或从不吸烟者相当。
无论首次 CV 事件发生时的年龄如何，首次 CV 事件后戒烟与复发性血管事件和全因死亡率的风险显著降低有关。由于戒烟在降低心血管风险方面比任何主要危险因素的药物治疗都更有效，因此它应该是血管疾病患者的一个关键目标。
