Stein James H, Smith Stevens S, Hansen Kristin M, Korcarz Claudia E, Piper Megan E, Fiore Michael C, Baker Timothy B
University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA.
University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA.
Atherosclerosis. 2020 Dec;315:62-67. doi: 10.1016/j.atherosclerosis.2020.11.010. Epub 2020 Nov 15.
We quantified the effects of smoking and smoking cessation on carotid artery atherosclerosis and wall thickness in two unique cohorts of smokers making a quit attempt.
Our primary analysis included 726 smokers making a quit attempt in a randomized clinical trial with long-term follow-up. Our secondary analysis included 889 smokers making a quit attempt in a subsequent trial. Participants underwent carotid artery ultrasonography at baseline and up to 3 subsequent visits. Primary outcomes were changes in carotid plaque score and intima media-thickness (IMT). We calculated a smoking burden score (SBS) that reflected the number of visits in which participants reported smoking after the quit attempt. Multivariable regression examined relations between SBS and carotid artery outcomes with adjustments for cardiovascular disease risk factors.
In the primary analysis, participants were mean (standard deviation) 46.1 (10.3) years old (57.9% female) and smoked 21.1 (8.9) cigarettes per day (CPD). After a median of 7 years, lower SBS predicted less increase in carotid plaque score (Chi-squared = 13.0, p = 0.012). SBS independently predicted change in carotid plaque score (p = 0.007; SBS 0 vs 4) as did baseline CPD (p = 0.024) and age (p<0.0001). SBS did not affect carotid IMT change. In the secondary analysis, increasing SBS was associated with increased likelihood of new plaques over 3 years among participants that smoked ≥15 CPD, (Chi-squared = 6.51, p = 0.011).
Smoking cessation is associated with less progression of carotid plaque, but not IMT. Salutary associations of smoking cessation with carotid plaque progression are related to degree of abstinence.
我们在两组尝试戒烟的独特吸烟者队列中，量化了吸烟及戒烟对颈动脉粥样硬化和管壁厚度的影响。
我们的主要分析纳入了726名在一项长期随访的随机临床试验中尝试戒烟的吸烟者。次要分析纳入了889名在后续试验中尝试戒烟的吸烟者。参与者在基线时及随后最多3次随访时接受颈动脉超声检查。主要结局为颈动脉斑块评分和内膜中层厚度（IMT）的变化。我们计算了一个反映参与者在尝试戒烟后报告仍在吸烟的随访次数的吸烟负担评分（SBS）。多变量回归分析在调整心血管疾病危险因素后，研究了SBS与颈动脉结局之间的关系。
在主要分析中，参与者的平均（标准差）年龄为46.1（10.3）岁（57.9%为女性），每天吸烟21.1（8.9）支。中位随访7年后，较低的SBS预示着颈动脉斑块评分增加较少（卡方检验=13.0，p=0.012）。SBS独立预测颈动脉斑块评分的变化（p=0.007；SBS为0与4相比），基线每日吸烟量（p=0.024）和年龄（p<0.0001）也有此作用。SBS不影响颈动脉IMT的变化。在次要分析中，对于每日吸烟≥15支的参与者，SBS增加与3年内出现新斑块的可能性增加相关（卡方检验=6.51，p=0.011）。
戒烟与颈动脉斑块进展减缓相关，但与IMT无关。戒烟与颈动脉斑块进展的有益关联与戒烟程度有关。
