Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
School of Public Health, Zhejiang University, Hangzhou, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Nutr Metab Cardiovasc Dis. 2024 May;34(5):1257-1266. doi: 10.1016/j.numecd.2024.01.005. Epub 2024 Jan 8.
To investigate the associations of ideal cardiovascular health metrics (ICVHMs) with all-cause mortality among former and current smokers compared with never smokers.
A total of 378,147 participants [mean age (SD) years: 56.3 (8.1); 47.2 % men] were included from the UK Biobank cohort. The ICVHMs were combined Life's simple 7 from the American Heart Association and sleep duration time. The association was explored using COX regression models. During a median follow-up of 13.3 years, we documented 24,594 deaths. Compared with never smokers, among former smokers, the multivariable-adjusted hazard ratio (HR) for all-cause mortality was 1.82 (95%CI 1.71-1.92) for participants who had ≤2 ICVHMs and 1.03 (0.97-1.10) for participants who had ≥6 ICVHMs; among current smokers, the HRs for mortality were 2.74 (2.60-2.89) and 2.18 (1.78-2.67). The phenomenon was more pronounced among participants younger than 60 years [HR (95%CI), 1.82 (1.71-1.95) for ≤2 ICVHMs vs 1.04 (0.96-1.12) for ≥6 ICVHMs with age ≥60 years and 1.83 (1.62-2.06) vs 0.98 (0.88-1.11) with age <60 years among former smokers; 2.66 (2.49-2.85) vs 2.44 (1.84-3.24) with age ≥60 years and 2.85 (2.62-3.10) vs 1.96 (1.47-2.61) with age <60 years among current smokers]. In addition, the HR for mortality of each 1-number increment in ICVHMs was 0.87 (0.86-0.89) among former smokers and 0.91 (0.89-0.94) among current smokers.
Our findings indicated the importance of adherence to have more ICVHMs in the mortality risk among former smokers, and priority of smoking cessation in current smokers.
Studies have found that former smokers still have higher risks of lung cancer and all-cause mortality than never-smokers. The next question is whether the effects of previous or current smoking could be ameliorated by eight ideal cardiovascular health metrics (ICVHMs). We aim to explore whether ICVHMs may counteract the risk of all-cause mortality among former and current smokers. The results showed that only former smokers with ≥6 ICVHMs exhibited a comparable risk of all-cause mortality with never smokers. Furthermore, current smokers even having ≥6 ICVHMs still exhibited a higher risk of all-cause mortality compared with never smokers.
本研究旨在调查与从不吸烟者相比，在既往吸烟者和当前吸烟者中，理想心血管健康指标（ICVHMs）与全因死亡率之间的关联。
共纳入来自英国生物库队列的 378147 名参与者（平均年龄（SD）岁：56.3（8.1）；47.2%为男性）。ICVHMs 由美国心脏协会的生命简单 7 项和睡眠时间组成。使用 COX 回归模型探讨了这种关联。在中位随访 13.3 年期间，我们记录了 24594 例死亡。与从不吸烟者相比，既往吸烟者中，拥有≤2 项 ICVHMs 的参与者的全因死亡率的多变量调整后的危险比（HR）为 1.82（95%CI 1.71-1.92），而拥有≥6 项 ICVHMs 的参与者的 HR 为 1.03（0.97-1.10）；当前吸烟者的死亡率 HR 分别为 2.74（2.60-2.89）和 2.18（1.78-2.67）。这一现象在年龄小于 60 岁的参与者中更为明显[HR（95%CI），≤2 项 ICVHMs 为 1.82（1.71-1.95），≥6 项 ICVHMs 为 1.04（0.96-1.12）；年龄≥60 岁和年龄<60 岁的既往吸烟者分别为 1.83（1.62-2.06）和 0.98（0.88-1.11）；年龄≥60 岁的 2.66（2.49-2.85）和年龄<60 岁的 2.44（1.84-3.24）；年龄≥60 岁的 2.85（2.62-3.10）和年龄<60 岁的 1.96（1.47-2.61）]。此外，既往吸烟者每增加 1 项 ICVHMs，死亡率的 HR 为 0.87（0.86-0.89），当前吸烟者的 HR 为 0.91（0.89-0.94）。
我们的研究结果表明，在既往吸烟者的死亡率风险中，坚持更多的 ICVHMs 非常重要，而当前吸烟者则应优先戒烟。
既往吸烟者的肺癌和全因死亡率仍高于从不吸烟者。接下来的问题是，以前或现在的吸烟行为是否可以通过八项理想心血管健康指标（ICVHMs）来改善。我们旨在探讨 ICVHMs 是否可以降低既往吸烟者和当前吸烟者的全因死亡率风险。结果表明，只有≥6 项 ICVHMs 的既往吸烟者全因死亡率风险与从不吸烟者相当。此外，即使当前吸烟者拥有≥6 项 ICVHMs，其全因死亡率的风险仍高于从不吸烟者。
