Vander Zwaag R, Lemp G F, Hughes J P, Ramanathan K B, Sullivan J M, Schick E C, Mirvis D M
Department of Health Services Research, Baptist Memorial Hospital, Memphis.
Chest. 1988 Aug;94(2):290-5. doi: 10.1378/chest.94.2.290.
Cigarette smoking is a risk factor for development of coronary atherosclerosis. We examined the relationship between smoking and the anatomic location of coronary artery stenosis in 8,705 patients undergoing cardiac catheterization for suspected coronary artery disease (CAD). The smoking history of patients with CAD (greater than or equal to 70 percent stenosis) was compared with that of control subjects (0 percent stenosis) for each of nine anatomic locations (proximal, middle, and distal segments of right [RCA], anterior descending [LAD], and circumflex arteries [LCX]), using a case-control method. The odds ratio (OR) estimate of relative risk of CAD for smokers relative to nonsmokers was 2.8, with a 95 percent confidence interval (CI) of 2.5 to 3.1. Relative risk was greater for RCA stenosis (OR = 5.8; CI = 4.6-7.2) than for LCX (OR = 3.5; CI = 2.7-4.5) or LAD (OR = 2.1; CI = 1.8-2.4) lesions when comparing smokers with nonsmokers. After control for age, gender, history of diabetes mellitus, and serum cholesterol level, the adjusted relative risk for an RCA lesion (Mantel-Haenszel odds ratio [MOR] = 4.9) was significantly elevated (p less than 0.05) compared with the LAD (MOR = 1.9) but not with the LCX (MOR = 3.1). The relative risks of CAD were the same (p greater than 0.05) for the proximal, middle, and distal coronary segments. Thus, smoking increased the risk of all coronary lesions but did so more for the RCA than for other vessels, suggesting a spatial pattern to the increased risk produced by smoking.
吸烟是冠状动脉粥样硬化发生的一个危险因素。我们在8705例因疑似冠状动脉疾病（CAD）接受心导管检查的患者中，研究了吸烟与冠状动脉狭窄解剖位置之间的关系。采用病例对照方法，比较了CAD患者（狭窄程度大于或等于70%）与对照组（狭窄程度为0%）在九个解剖位置（右冠状动脉[RCA]、前降支动脉[LAD]和回旋支动脉[LCX]的近端、中段和远端节段）的吸烟史。吸烟者相对于不吸烟者患CAD的相对风险的比值比（OR）估计值为2.8，95%置信区间（CI）为2.5至3.1。与不吸烟者相比，RCA狭窄的相对风险（OR = 5.8；CI = 4.6 - 7.2）高于LCX（OR = 3.5；CI = 2.7 - 4.5）或LAD（OR = 2.1；CI = 1.8 - 2.4）病变。在控制年龄、性别、糖尿病史和血清胆固醇水平后，与LAD（MOR = 1.9）相比，RCA病变的调整后相对风险（Mantel - Haenszel比值比[MOR] = 4.9）显著升高（p小于0.05），但与LCX（MOR = 3.1）相比则没有。CAD在冠状动脉近端、中段和远端节段的相对风险相同（p大于0.05）。因此，吸烟增加了所有冠状动脉病变的风险，但对RCA的影响比对其他血管更大，这表明吸烟导致的风险增加存在空间模式。
