Liu Xinhui, Zhang Heng, Li Hongkai, Xue Fuzhong
Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China.
Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China.
BMC Public Health. 2025 May 1;25(1):1609. doi: 10.1186/s12889-025-22865-3.
The present study aims to investigate the association of smoking behaviors and cardiovascular-kidney-metabolic (CKM) syndrome with incident cardiovascular disease (CVD), and to evaluate whether the cardiovascular benefits of smoking cessation vary across different CKM conditions.
This study included 242,636 white European participants from the UK Biobank who were classified as CKM syndrome Stages 0 to 3 and free of CVD at baseline. Covariates adjusted Cox proportional hazards models were employed to evaluate the associations of CKM syndrome with the risks of total CVD, stroke, coronary heart disease (CHD), major adverse cardiovascular events (MACE), and 13 CVD subtypes. The impact of smoking behavior across different CKM stages and the joint effect of smoking and CKM syndrome on CVD risk were also evaluated. To investigate the potential effect modification by CKM syndrome, we examined the multiplicative scale by interaction terms in Cox models, and quantified the additive scale using statistics such as the relative excess risk due to interaction (RERI).
The risk of total CVD, stroke, and CHD increased progressively with advancing CKM stages, with Stage 3 associated with hazard ratios (HRs) of 3.38 (95% CI: 3.05-3.74), 3.01 (2.49-3.64), and 3.65 (3.25-4.10), respectively (P for trend < 0.001). The time required to reduce CVD risk to a level not significantly different from that of never smokers tends to be longer for individuals with advancing CKM stage: smokers at Stages 0-1 achieved this after approximately 10 years of cessation, whereas those at Stages 2-3 required more than 25 years. Compared with never smokers at CKM Stage 0, current smokers at CKM Stage 3 had substantially higher risk of total CVD (HR = 4.14, 95% CI: 3.54-4.83) and several subtypes, particularly abdominal aortic aneurysm (HR = 17.68, 95% CI: 6.33-49.43) and peripheral vascular disease (HR = 10.53, 95% CI: 6.79-16.34). CKM syndrome appeared to act as a positive additive effect modifier in smoking-related risk of total CVD (RERI = 0.20, 95% CI: 0.05-0.32), as well as several CVD subtypes, suggesting that the combined effect of smoking and CKM progression exceeds the sum of their individual effects.
Our finding emphasizes the importance of smoking cessation among individuals with advanced CKM syndrome, as they face heightened CVD risk. However, compared to those at earlier CKM stages, the short-term benefits of smoking cessation may be less pronounced in this population. Interventions that combine smoking cessation promotion with CKM syndrome management may yield greater reductions in the risk of several CVD outcomes.
本研究旨在调查吸烟行为和心血管 - 肾脏 - 代谢（CKM）综合征与心血管疾病（CVD）发病之间的关联，并评估戒烟对心血管的益处是否因不同的CKM状况而有所不同。
本研究纳入了来自英国生物银行的242,636名欧洲白人参与者，他们在基线时被分类为CKM综合征0至3期且无CVD。采用协变量调整的Cox比例风险模型来评估CKM综合征与总CVD、中风、冠心病（CHD）、主要不良心血管事件（MACE）以及13种CVD亚型风险之间的关联。还评估了不同CKM阶段吸烟行为的影响以及吸烟与CKM综合征对CVD风险的联合作用。为了研究CKM综合征的潜在效应修正作用，我们在Cox模型中通过交互项检验了相乘尺度，并使用诸如交互作用所致相对超额风险（RERI）等统计量来量化相加尺度。
总CVD、中风和CHD的风险随着CKM阶段的进展而逐渐增加，3期的风险比（HR）分别为3.38（95%CI：3.05 - 3.74）、3.01（2.49 - 3.64）和3.65（3.25 - 4.10）（趋势P < 0.001）。CKM阶段进展的个体将CVD风险降低到与从不吸烟者无显著差异水平所需的时间往往更长：0 - 1期的吸烟者在戒烟约10年后达到这一水平，而2 - 3期的吸烟者则需要超过25年。与CKM 0期的从不吸烟者相比，CKM 3期的当前吸烟者患总CVD（HR = 4.14，95%CI：3.54 - 4.83）和几种亚型的风险显著更高, 特别是腹主动脉瘤（HR = 17.68，95%CI：6.33 - 49.43）和外周血管疾病（HR = 10.53，95%CI：6.79 - 16.34）。CKM综合征似乎在吸烟相关的总CVD风险（RERI = 0.20，95%CI：0.05 - 0.32）以及几种CVD亚型中起到正向相加效应修正作用，这表明吸烟与CKM进展的联合效应超过了它们各自效应的总和。
我们的研究结果强调了在晚期CKM综合征患者中戒烟的重要性，因为他们面临更高的CVD风险。然而，与CKM早期阶段的患者相比，戒烟在这一人群中的短期益处可能不太明显。将促进戒烟与CKM综合征管理相结合的干预措施可能会更大程度地降低几种CVD结局的风险。
