Negri E, La Vecchia C, Nobili A, D'Avanzo B, Bechi S
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Eur J Epidemiol. 1994 Aug;10(4):361-6. doi: 10.1007/BF01719657.
To make a further quantitative assessment of the relationship between cigarette smoking and the risk of myocardial infarction, a multicentric case-control study was conducted in Italy between September 1988 and June 1989 within the framework of the GISSI-2 trial. Ninety hospitals in various Italian Regions participated. 916 cases of acute myocardial infarction with no history of ischaemic heart disease and 1106 controls admitted to hospital for acute conditions not related to known or suspected risk factors for ischaemic heart disease were studied. Relative risks (RR) and 95% confidence intervals (CI) of myocardial infarction according to various measures of tobacco smoking, were adjusted for identified potential confounding factors using multiple logistic regression. Compared to lifelong non-smokers, the RR was 1.3 (95% CI 1.0 to 1.9) for ex-smokers, 2.0 (95% CI 1.4 to 2.9) for current smokers of less than 15 cigarettes per day, 3.1 (95% CI 2.2 to 4.2) for 15-24 cigarettes per day and 4.9 (95% CI 3.4 to 7.1) for 25 or more cigarettes per day. No trend in risk was evident for the duration, the RR being around 3 for subsequent categories. There was a significant interaction between smoking and age. Below the age 45, smokers of 25 or more cigarettes per day had a 33 times higher risk than non-smokers, compared to 7.5 at in the age group 45-54, 4.4 between the ages 55-64 and 2.5 at the age of 65 or over. The risk estimates were higher in women (RR for > or = 25 cigarettes per day = 10.1), in subjects in the lowest cholesterol tertile (RR = 11.9), with no history of diabetes (RR = 6.8), hypertension (RR = 9.5), no family history ischaemic heart disease (RR = 9.1) and low body mass index (RR = 9.3). The importance of smoking is confirmed as a cause of acute myocardial infarction: about 50% of all nonfatal infarctions in this Italian population could be attributable to cigarette smoking.(ABSTRACT TRUNCATED AT 250 WORDS)
为了进一步定量评估吸烟与心肌梗死风险之间的关系，1988年9月至1989年6月在意大利开展了一项多中心病例对照研究，该研究在GISSI - 2试验框架内进行。意大利不同地区的90家医院参与其中。研究了916例无缺血性心脏病病史的急性心肌梗死病例以及1106名因与已知或疑似缺血性心脏病危险因素无关的急性病症入院的对照者。根据吸烟的不同衡量指标，通过多因素逻辑回归对已识别的潜在混杂因素进行调整后，得出心肌梗死的相对风险（RR）和95%置信区间（CI）。与终身不吸烟者相比，既往吸烟者的RR为1.3（95%CI 1.0至1.9），每天吸烟少于15支的当前吸烟者为2.0（95%CI 1.4至2.9），每天吸15 - 24支的为3.1（95%CI 2.2至4.2），每天吸25支或更多的为4.9（95%CI 3.4至7.1）。风险在持续时间方面无明显趋势，后续类别RR约为3。吸烟与年龄之间存在显著交互作用。45岁以下，每天吸25支或更多香烟的吸烟者比不吸烟者风险高33倍，45 - 54岁年龄组为7.5倍，55 - 64岁之间为4.4倍，65岁及以上为2.5倍。在女性（每天吸≥25支香烟的RR = 10.1）、胆固醇处于最低三分位数的受试者（RR = 11.9）、无糖尿病病史者（RR = 6.8）、高血压患者（RR = 9.5）、无缺血性心脏病家族史者（RR = 9.1）以及低体重指数者（RR = 9.3）中，风险估计值更高。吸烟作为急性心肌梗死病因的重要性得到证实：在该意大利人群中，约50%的非致命性梗死可归因于吸烟。（摘要截选至250字）
