Taylor B V, Oudit G Y, Kalman P G, Liu P
School of Medicine, University of Toronto, Ontario.
Can J Cardiol. 1998 Sep;14(9):1129-39.
Both passive and active cigarette smoking increase the risk of cardiovascular disease, the leading cause of death in Western industrialized nations. The prevalence of smoking as a major cardiovascular risk factor has been well characterized over the past 30 years. The two demographic groups of particular concern are women and the young. The relationship between active tobacco smoking and increased risk of coronary artery disease (stable and unstable angina, acute myocardial infarction or sudden death), cerebrovascular disease (cerebral infarction, and cerebral and subarachnoid hemorrhage), peripheral arterial disease (large and small vessel) and aortic aneurysm has been well established in numerous longitudinal and cross-sectional epidemiological and basic science studies. More recently, passive smoking has been shown to represent an important risk factor for coronary artery disease. Smoking can elicit both acute and chronic cardiac and vascular events due to the multiplicity of mechanisms involved: hematological, neurohormonal, metabolic, hemodynamic, molecular genetic and biochemical pathways. Smoking cessation can result in both the inhibition of progression and the regression of pathophysiological changes, improving morbidity and mortality among chronic smokers. The incidence of coronary artery and cerebrovascular diseases in former smokers decreases by 50% two to three years following cessation, but a small long term excess risk persists. Smoking as a cardiovascular risk factor and the clinical cardiovascular features associated with active and passive smoking are discussed, and a pathophysiological framework to explain the association between cigarette smoking and cardiovascular disease is provided.
主动吸烟和被动吸烟都会增加心血管疾病的风险，而心血管疾病是西方工业化国家的主要死因。在过去30年里，吸烟作为主要心血管危险因素的流行情况已得到充分描述。特别值得关注的两个人口群体是女性和年轻人。在众多纵向和横断面流行病学及基础科学研究中，主动吸烟与冠状动脉疾病（稳定型和不稳定型心绞痛、急性心肌梗死或猝死）、脑血管疾病（脑梗死、脑出血和蛛网膜下腔出血）、外周动脉疾病（大血管和小血管）以及主动脉瘤风险增加之间的关系已得到充分证实。最近，被动吸烟已被证明是冠状动脉疾病的一个重要危险因素。由于涉及多种机制：血液学、神经激素、代谢、血流动力学、分子遗传学和生化途径，吸烟可引发急性和慢性心脏及血管事件。戒烟可抑制病理生理变化的进展并使其逆转，从而改善慢性吸烟者的发病率和死亡率。戒烟两到三年后，既往吸烟者患冠状动脉疾病和脑血管疾病的发生率会降低50%，但仍存在长期的小额外在风险。本文讨论了吸烟作为心血管危险因素以及与主动吸烟和被动吸烟相关的临床心血管特征，并提供了一个病理生理框架来解释吸烟与心血管疾病之间的关联。
