Kawachi I, Colditz G A, Stampfer M J, Willett W C, Manson J E, Rosner B, Speizer F E, Hennekens C H
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, Mass.
Arch Intern Med. 1994 Jan 24;154(2):169-75.
We examined prospectively the relation of time since stopping smoking with risk of coronary heart disease in middle-aged women.
The study was based on 12 years' follow-up data (1976 through 1988) from the Nurses' Health Study, an ongoing prospective cohort study, in which information on smoking habits was updated every 2 years by a mailed questionnaire. The study population consisted of 117,006 female registered nurses aged 30 to 55 years in 1976 who were free of coronary heart disease, stroke, and cancer at baseline. The outcome measure used was incident coronary heart disease, defined as nonfatal myocardial infarction plus fatal coronary heart disease.
A total of 970 incident cases of coronary heart disease (215 among participants who never smoked, 214 among former smokers, and 541 among current smokers) occurred during 1.37 million person-years of follow-up. The multivariate relative risk of total coronary heart disease among current smokers compared with participants who never smoked was 4.23 (95% confidence interval, 3.60 to 4.96). Risk of coronary heart disease was highest among smokers who started smoking before the age of 15 years (relative risk, 9.25; 95% confidence interval, 5.27 to 16.23). The relative risk among former smokers was 1.48 (95% confidence interval, 1.22 to 1.79). On stopping smoking, one third of the excess risk of coronary heart disease was eliminated within 2 years of cessation. Thereafter, the excess risk returned to the level of those who never smoked during the interval 10 to 14 years following cessation.
Women who stop smoking will experience an immediate benefit as well as a further longer-term decline in excess risk of coronary heart disease to the level of those who never smoked.
我们前瞻性地研究了中年女性戒烟时间与冠心病风险之间的关系。
本研究基于护士健康研究12年的随访数据（1976年至1988年），这是一项正在进行的前瞻性队列研究，其中吸烟习惯信息每2年通过邮寄问卷进行更新。研究人群包括1976年年龄在30至55岁之间、基线时无冠心病、中风和癌症的117,006名女性注册护士。所使用的结局指标为新发冠心病，定义为非致死性心肌梗死加致死性冠心病。
在137万人年的随访期间，共发生了970例冠心病事件（从不吸烟者中有215例，既往吸烟者中有214例，当前吸烟者中有541例）。与从不吸烟者相比，当前吸烟者中冠心病的多因素相对风险为4.23（95%置信区间，3.60至4.96）。15岁之前开始吸烟的吸烟者中冠心病风险最高（相对风险，9.25；95%置信区间，5.27至16.23）。既往吸烟者的相对风险为1.48（95%置信区间，1.22至1.79）。戒烟后，冠心病额外风险的三分之一在戒烟后2年内消除。此后，在戒烟后的10至14年期间，额外风险恢复到从不吸烟者的水平。
戒烟的女性将立即受益，并且冠心病额外风险会进一步长期下降至从不吸烟者的水平。
