National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.
Eur J Epidemiol. 2022 Apr;37(4):423-428. doi: 10.1007/s10654-021-00835-4. Epub 2022 Feb 5.
Though evidence suggests that higher cardiorespiratory fitness (CRF) levels can offset the adverse effects of other risk factors, it is unknown if CRF offsets the increased risk of chronic obstructive pulmonary disease (COPD) due to smoking. We aimed to evaluate the combined effects of smoking status and CRF on incident COPD risk using a prospective cohort of 2295 middle-aged and older Finnish men. Peak oxygen uptake, assessed with a respiratory gas exchange analyzer, was used as a measure of CRF. Smoking status was self-reported. CRF was categorised as low and high based on median cutoffs, whereas smoking status was classified into smokers and non-smokers. Multivariable-adjusted hazard ratios with confidence intervals (CIs) were calculated. During 26 years median follow-up, 119 COPD cases were recorded. Smoking increased COPD risk 10.59 (95% CI 6.64-16.88), and high CRF levels decreased COPD risk 0.43 (95% CI 0.25-0.73). Compared with non-smoker-low CRF, smoker-low CRF was associated with an increased COPD risk in multivariable analysis 9.79 (95% CI 5.61-17.08), with attenuated but persisting evidence of an association for smoker-high CRF and COPD risk 6.10 (95% CI 3.22-11.57). An additive interaction was found between smoking status and CRF (RERI = 6.99). Except for CRF and COPD risk, all associations persisted on accounting for mortality as a competing risk event. Despite a wealth of evidence on the ability of high CRF to offset the adverse effects of other risk factors, it appears high CRF levels have only modest attenuating effects on the very strong association between smoking and COPD risk.
虽然有证据表明较高的心肺适能（CRF）水平可以抵消其他风险因素的不利影响，但尚不清楚 CRF 是否可以抵消因吸烟而导致的慢性阻塞性肺疾病（COPD）风险增加。我们旨在通过对 2295 名中年及以上芬兰男性的前瞻性队列研究，评估吸烟状况和 CRF 对 COPD 发病风险的综合影响。使用呼吸气体交换分析仪评估最大摄氧量作为 CRF 的衡量标准。吸烟状况为自我报告。根据中位数的截断值，将 CRF 分为低和高，而吸烟状况分为吸烟者和非吸烟者。计算了多变量校正的危险比及其置信区间（CI）。在 26 年的中位随访期间，记录了 119 例 COPD 病例。吸烟使 COPD 风险增加了 10.59（95%CI6.64-16.88），而高 CRF 水平降低了 COPD 风险 0.43（95%CI0.25-0.73）。与非吸烟者低 CRF 相比，吸烟者低 CRF 在多变量分析中与 COPD 风险增加相关，比值比为 9.79（95%CI5.61-17.08），对于吸烟者高 CRF 和 COPD 风险，这种关联仍然存在但有所减弱，比值比为 6.10（95%CI3.22-11.57）。发现吸烟状况和 CRF 之间存在相加交互作用（RERI=6.99）。除了 CRF 和 COPD 风险外，在考虑死亡率作为竞争风险事件的情况下，所有关联仍然存在。尽管有大量证据表明高 CRF 能够抵消其他风险因素的不利影响，但似乎高 CRF 水平对吸烟与 COPD 风险之间非常强的关联只有适度的减弱作用。
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