Colditz G A, Bonita R, Stampfer M J, Willett W C, Rosner B, Speizer F E, Hennekens C H
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, MA.
N Engl J Med. 1988 Apr 14;318(15):937-41. doi: 10.1056/NEJM198804143181501.
It is known that cigarette smoking is associated with increased risk of both thrombotic and hemorrhagic stroke among men. To test for such an association among women, we examined the incidence of stroke in relation to cigarette smoking in a prospective cohort study of 118,539 women 30 to 55 years of age and free from coronary heart disease, stroke, and cancer in 1976. During eight years of follow-up (908,447 person-years), we identified 274 strokes, comprising 71 subarachnoid hemorrhages, 26 intracerebral hemorrhages, 122 thromboembolic strokes, and 55 strokes about which information was insufficient to permit classification. The number of cigarettes smoked per day was associated positively with the risk of stroke. Compared with the women who had never smoked, those who smoked 1 to 14 cigarettes per day had an age-adjusted relative risk of 2.2 (95 percent confidence interval, 1.5 to 3.3), whereas those who smoked 25 or more cigarettes per day had a relative risk of 3.7 (95 percent confidence interval, 2.7 to 5.1). For women in this latter group, the relative risk of subarachnoid hemorrhage was 9.8 (95 percent confidence interval, 5.3 to 17.9), as compared with those who had never smoked. Adjustment for the effects of relative weight, hypertension, diabetes, history of high cholesterol, previous use of oral contraceptives, postmenopausal estrogen therapy, and alcohol intake did not appreciably alter the association between cigarette use and incidence of stroke. These prospective data support a strong causal relation between cigarette smoking and stroke among young and middle-aged women.
众所周知，男性吸烟会增加血栓性和出血性中风的风险。为了检验女性中是否存在这种关联，我们在一项前瞻性队列研究中，对1976年年龄在30至55岁之间且无冠心病、中风和癌症的118,539名女性进行了吸烟与中风发病率关系的研究。在八年的随访期（908,447人年）内，我们确定了274例中风病例，包括71例蛛网膜下腔出血、26例脑出血、122例血栓栓塞性中风以及55例因信息不足无法分类的中风病例。每日吸烟量与中风风险呈正相关。与从不吸烟的女性相比，每天吸1至14支烟的女性经年龄调整后的相对风险为2.2（95%置信区间为1.5至3.3），而每天吸25支或更多支烟的女性相对风险为3.7（95%置信区间为2.7至5.1）。对于后一组女性，与从不吸烟的女性相比，蛛网膜下腔出血的相对风险为9.8（95%置信区间为5.3至17.9）。对相对体重、高血压、糖尿病、高胆固醇病史、既往口服避孕药使用情况、绝经后雌激素治疗以及酒精摄入量的影响进行调整后，吸烟与中风发病率之间的关联没有明显改变。这些前瞻性数据支持了年轻和中年女性吸烟与中风之间存在强烈因果关系。
