Department of Cardiology, Nagoya City University Graduate School of Medical Sciences.
Health Support Center WELPO, Toyota Motor Corporation.
J Atheroscler Thromb. 2020 Nov 1;27(11):1230-1242. doi: 10.5551/jat.55996. Epub 2020 Jun 14.
Cigarette smoking provokes deleterious influences on cardiovascular and pulmonary systems, although the underlying relationship has not been sufficiently investigated especially in early-stage disease. The present study investigated possible associations between subclinical atherosclerosis and pulmonary function in middle-aged male smokers.
Male smokers undergoing their periodic health check-up were enrolled in this study (n=3,775, 45±8 years). Pulmonary function was evaluated using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in one second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC). Subclinical atherosclerosis was assessed based on ankle-brachial pressure index (ABI), cardio-ankle vascular index (CAVI), ultrasound examination of the carotid intima-media thickness (IMT), and presence of plaque.
Multivariate regression analysis showed that ABI was positively associated with FVC%-predicted and FEV1%-predicted after adjustment for confounders including smoking intensity, while CAVI or carotid IMT was inversely associated with both. Participants with chronic obstructive pulmonary disease (COPD, n=256) showed reduced ABI and increased CAVI or carotid IMT compared with those without COPD, and participants with carotid plaque had lower pulmonary function than those without plaque. Reduced FEV1/FVC was an independent determinant of carotid plaque and decreased ABI was an independent determinant of COPD, as revealed by logistic regression analysis with the endpoint of carotid plaque presence or a diagnosis of COPD revealed.
Middle-aged male smokers showed a close association between subclinical atherosclerosis and pulmonary function, implying that smoking induced-vascular and pulmonary damage are interacting in early-stage disease.
吸烟会对心血管和肺部系统造成有害影响，尽管其潜在关系尚未得到充分研究，尤其是在疾病早期阶段。本研究旨在探讨中年男性吸烟者亚临床动脉粥样硬化与肺功能之间的可能关联。
本研究纳入了接受定期健康检查的中年男性吸烟者（n=3775，年龄 45±8 岁）。通过肺活量测定法评估肺功能，计算用力肺活量（FVC）占预计值的百分比（FVC%-predicted）、一秒用力呼气容积（FEV1）占预计值的百分比（FEV1%-predicted）以及 FEV1 与 FVC 的比值（FEV1/FVC）。基于踝臂血压指数（ABI）、心踝血管指数（CAVI）、颈动脉内膜中层厚度（IMT）超声检查以及斑块的存在评估亚临床动脉粥样硬化。
多变量回归分析显示，在调整包括吸烟强度在内的混杂因素后，ABI 与 FVC%-predicted 和 FEV1%-predicted 呈正相关，而 CAVI 或颈动脉 IMT 与两者均呈负相关。与无 COPD 的患者相比，患有慢性阻塞性肺疾病（COPD，n=256）的患者 ABI 降低，CAVI 或颈动脉 IMT 增加，而颈动脉斑块患者的肺功能较无斑块者降低。FEV1/FVC 降低是颈动脉斑块的独立决定因素，ABI 降低是 COPD 的独立决定因素，这是通过以颈动脉斑块存在或 COPD 诊断为终点的逻辑回归分析得出的。
中年男性吸烟者的亚临床动脉粥样硬化与肺功能密切相关，这表明吸烟引起的血管和肺部损伤在疾病早期阶段相互作用。
