Omori Naoki, Ikawa Fusao, Chiku Masaaki, Kitamura Naoyuki, Tomimoto Hidekazu, Aoyama Atsuo, Shuhei Yamaguchi, Nagai Atsushi
Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan,
Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
Cerebrovasc Dis. 2025;54(4):460-466. doi: 10.1159/000541657. Epub 2024 Sep 30.
Cerebral small-vessel disease (CSVD) is a common cause of cognitive decline and stroke. Several studies have shown that smoking is a risk factor for CSVD progression. However, the extent to which smoking exacerbates CSVD lesions remains unclear. In this study, we aimed to clarify the association between total smoking exposure and the severity of CSVD in healthy participants.
We analyzed the data of participants aged ≥50 years who underwent brain screening. The participants' age, sex, body mass index, alcohol consumption history, and medical history (hypertension, diabetes mellitus, and dyslipidemia) were investigated. Smoking status was assessed in pack-years, and smokers were classified as current or past smokers. CSVD findings on magnetic resonance imaging were used to evaluate the severity of periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DSWMH), and enlarged perivascular spaces (EPVSs). The EPVSs were measured in the basal ganglia and centrum semiovale regions. Multivariable ordinal logistic regression analyses were performed to evaluate the effect of smoking, adjusted for the participants' baseline characteristics.
A total of 2,137 participants were included in this study. The mean age of the participants was 58.7 years. The mean pack-years were 20.5 for past smokers and 26.8 for current smokers. Among current smokers, increased pack-years were significantly associated with a high EPVS burden in the basal ganglia (odds ratio: 1.14, 95% confidence interval: 1.00-1.28), whereas no such significant association was found for past smokers. No statistically significant association was found between pack-years and the risks of PVH, DSWMH, or EPVS in the centrum semiovale.
Current smoking was associated with a dose-dependent risk of EPVS in the basal ganglia in healthy participants.
脑小血管病（CSVD）是认知功能下降和中风的常见原因。多项研究表明，吸烟是CSVD进展的危险因素。然而，吸烟加剧CSVD病变的程度仍不清楚。在本研究中，我们旨在阐明健康参与者的总吸烟暴露量与CSVD严重程度之间的关联。
我们分析了年龄≥50岁且接受脑部筛查的参与者的数据。调查了参与者的年龄、性别、体重指数、饮酒史和病史（高血压、糖尿病和血脂异常）。吸烟状况以吸烟包年数评估，吸烟者分为当前吸烟者或既往吸烟者。利用磁共振成像上的CSVD表现来评估脑室周围高信号（PVH）、深部皮质下白质高信号（DSWMH）和血管周围间隙扩大（EPVS）的严重程度。在基底节区和半卵圆中心区域测量EPVS。进行多变量有序逻辑回归分析，以评估吸烟的影响，并对参与者的基线特征进行调整。
本研究共纳入2137名参与者。参与者的平均年龄为58.7岁。既往吸烟者的平均吸烟包年数为20.5，当前吸烟者为26.8。在当前吸烟者中，吸烟包年数增加与基底节区EPVS负担加重显著相关（优势比：1.14，95%置信区间：1.00-1.28），而既往吸烟者未发现此类显著关联。在半卵圆中心，吸烟包年数与PVH、DSWMH或EPVS的风险之间未发现统计学显著关联。
在健康参与者中，当前吸烟与基底节区EPVS的剂量依赖性风险相关。
