Department of Biomedical Sciences (S.C., S.M.P.), Seoul National University College of Medicine, South Korea.
Department of Family Medicine (K.L., S.M.P.), Seoul National University College of Medicine, South Korea.
Circulation. 2021 Nov 9;144(19):1528-1538. doi: 10.1161/CIRCULATIONAHA.121.054967. Epub 2021 Oct 4.
The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear.
The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits.
Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk.
Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.
非燃烧尼古丁或烟草制品（NNTP）和可燃香烟（CC）使用习惯变化与随后的心血管疾病（CVD）风险之间的关联仍不清楚。
研究人群由来自韩国国家健康保险服务数据库的 5159538 名成年男性组成，他们在第一次（2014-2015 年）和第二次（2018 年）健康筛查期间接受了健康筛查检查。所有参与者分为连续只吸 CC 的吸烟者、CC 和 NNTP 使用者、近期（<5 年）无 NNTP 使用的 CC 戒烟者、近期有 NNTP 使用的 CC 戒烟者、长期（≥5 年）无 NNTP 使用的 CC 戒烟者、长期有 NNTP 使用的 CC 戒烟者和从不吸烟者。进行倾向评分匹配分析，以进一步比较根据 NNTP 使用情况，CC 戒烟者的 CVD 风险。从第二次健康筛查日期开始，参与者将被随访，直到发生 CVD 事件、死亡或 2019 年 12 月 31 日（以最早者为准）。多变量 Cox 比例风险回归用于确定根据 NNTP 和 CC 吸烟习惯的变化，CVD 风险的调整后危险比（aHR）和 95%CI。
与连续只吸 CC 的吸烟者相比，CC 和 NNTP 使用者（aHR，0.83 [95%CI，0.79-0.88]）和最初吸 CC 的吸烟者戒烟并仅改用 NNTP 使用者（近期有 NNTP 使用的 CC 戒烟者，aHR，0.81 [95%CI，0.78-0.84]）患 CVD 的风险较低。经过倾向评分匹配后，近期有 NNTP 使用的 CC 戒烟者（aHR，1.31 [95%CI，1.01-1.70]）患 CVD 的风险高于近期无 NNTP 使用的 CC 戒烟者。同样，与长期无 NNTP 使用的 CC 戒烟者相比，长期有 NNTP 使用的 CC 戒烟者（aHR，1.70 [95%CI，1.07-2.72]）患 CVD 的风险更高。
最初吸 CC 的吸烟者改用 NNTP 与较低的 CVD 风险相关，而持续吸 CC 与较高的 CVD 风险相关。在 CC 戒断后，与不使用 NNTP 的 CC 戒烟相比，使用 NNTP 与更高的 CVD 风险相关。与不使用 NNTP 的 CC 吸烟者相比，使用 NNTP 的 CC 戒烟者未来可能面临更高的 CVD 风险。
