吸烟与心血管疾病

1、吸烟与心血管疾病吸烟与心血管疾病吸烟是中国人心血管疾病的重要危险因素吸烟是中国人心血管疾病的重要危险因素中国nehns iv冠心病冠心病是吸烟致死疾病的前三位之一是吸烟致死疾病的前三位之一由吸烟引起死亡的前三位疾病：由吸烟引起死亡的前三位疾病：国外资料为：国外资料为：copdcopd冠心病肺冠心病肺caca国内资料为：国内资料为：copdcopd肺肺caca冠心病冠心病1. surgeoen generals report. health consequences of smoking; 2004. 2. j natl cancer inst. 1993;85(24):1994. 3. cra

2、ne. cancer epidemiol biomarkers prev. 1996;5(8):639. 4. miligi. am j ind med. 1999;36(1):60. 5. roman. cerebrovasc dis, 2005;20(suppl 2):91. 6. willigendael. j vasc surg. 2004;40:1158. 7. yang. bmj. 1999;319:143lavi et al. circulation. 2007;115:2621-2627; /hic/topics

3、/diag/diangio.cfm. accessed june 14, 2007.右冠状动脉粥样硬化右冠状动脉粥样硬化吸烟促发心血管疾病的发病机理吸烟促发心血管疾病的发病机理sambola et al. circulation. 2003;107:973-977.factor xa (fxa) pmol/l/minp=.0032172830100200300400吸烟者吸烟前（2支烟）吸烟者吸烟后(2支烟)吸烟使血栓生成增加吸烟使血栓生成增加barua et al. circulation. 2001;104:1905-1910.50000不吸烟者吸烟者4000300020001000no浓

4、度浓度 (nmol/l)p.000112663613吸烟使一氧化氮生物合成减少吸烟使一氧化氮生物合成减少zeiher et al. circulation. 1995;92:1094-1100.020304060501010p.01p.001p.01吸烟者吸烟者p.01不吸烟者不吸烟者p.01动脉造影正常的吸烟者动脉造影不正常的吸烟者动脉造影正常的不吸烟者动脉造影不正常的不吸烟者流量调节的内皮血管舒张功能流量调节的内皮血管舒张功能吸烟使血管内皮舒张功能受损吸烟使血管内皮舒张功能受损lavi et al. circulation. 2007;115:2621-2627.p=.0360453015

5、0不吸烟者戒烟者吸烟者46%34%35%内皮功能障碍内皮功能障碍吸烟致心外膜血管内皮功能障碍吸烟致心外膜血管内皮功能障碍lavi et al. circulation. 2007;115:2621-2627; stewart et al. circulation. 2005;111:1756-176286420p.0001p=.03p.0001p.0001吸烟者戒烟者白细胞中性粒细胞淋巴细胞单核细胞不吸烟者细胞计数细胞计数109/l吸烟使白细胞计数升高吸烟使白细胞计数升高ns=not significant. a unless marked as “ns,” differences for e

6、ach value between groups were statistically significant at a level of p.05. schmid et al. thromb res. 1996;81:451-460.不吸烟者吸烟者pg/mla36.834.832.830.828.826.824.822.8123451211-脱氢血栓烷素脱氢血栓烷素b2 nsnsnsmin/10 plateletsa1234512丙二醛丙二醛天天3.64.0nsnsnsnsnsnsnsnsnsns天天吸烟使血小板聚集功能增强吸烟使血小板聚集功能增强异构前列

7、腺素f2 水平是体内脂质过氧化反应的指标the dots representing subjects who smoked are each connected to a dot representing a nonsmoker matched to the subject for age and sex.adapted from morrow et al. n engl j med. 1995;332(18):1198-1203.64056048040032024016080吸烟者不吸烟者1000900800700600500400300吸烟者不吸烟者自由异构前列腺素自由异构前列腺素f2pm

8、ol/l酯化异构前列腺素酯化异构前列腺素f2pmol/l吸烟增加氧化修饰吸烟增加氧化修饰吸烟与心血管疾病的流行病学吸烟与心血管疾病的流行病学吸烟流行吸烟流行10年后出现吸烟相关疾病的流行年后出现吸烟相关疾病的流行吸烟与冠心病吸烟与冠心病 (cad)waters et al. circulation. 1996;94:614-621. 已有病变加重的发生率已有病变加重的发生率吸烟者非吸烟者新病变发生率新病变发生率吸烟者p=.002p=.007非吸烟者患者百分率患者百分率吸烟加重动脉粥样硬化吸烟加重动脉粥样硬化athe probability of an event (developing a d

9、isease) occurring in exposed people compared with the probability of the event in nonexposed people. adjusted for age.willett et al. n engl j med. 1987;317(1):1303-1309.吸烟者每日吸烟量吸烟者每日吸烟量相对风险可信区间95吸烟增加心绞痛风险吸烟增加心绞痛风险athe ratio of the odds of development of disease in exposed persons to the odds of deve

10、lopment of disease in nonexposed persons.teo. lancet. 2006;368:647-658.风险比可信区间95吸烟增加急性非致死性心梗的风险吸烟增加急性非致死性心梗的风险y usuf s et al . lancet. 2004;364:937-52or (99% ci)每日吸烟量与心肌梗死发生有量效关系每日吸烟量与心肌梗死发生有量效关系a the probability of an event (developing a disease) occurring in exposed people compared with the probab

11、ility of the event in nonexposed people. adjusted for age.willett et al. n engl j med. 1987;317(21):1303-1309.吸烟者每日吸烟量吸烟者每日吸烟量相对风险可信区间95吸烟增加冠心病死亡风险吸烟增加冠心病死亡风险athe probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed peopl

12、e. adjusted for age.wannamethee et al. circulation. 1995;91:1749-1756.1.02.30.01.02.03.04.0不吸烟者吸烟者相对风险可信区间95吸烟增加心源性猝死的风险吸烟增加心源性猝死的风险athe probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people. adjusted for the baseli

13、ne variables significantly associated with each end point.hasdai et al. n engl j med. 1997;336:755-761.q波心梗波心梗 (mi)相对风险可信区间950.01.02.03.04.0不吸烟者戒烟者吸烟者吸烟使冠脉介入治疗后发生吸烟使冠脉介入治疗后发生q波心梗的风险波心梗的风险增高增高被动吸烟与冠心病被动吸烟与冠心病adjusted for age, systolic blood pressure, diastolic blood pressure, total cholesterol, hdl c

14、holesterol, fev, height, preexisting cad, body mass index, triglycerides, white cell count, diabetes, physical activity, alcohol intake, and social class. alight active refers to men smoking 1-9 cigarettes a day. bheavy passive refers to upper three quarters of cotinine concentration combined (0.8 t

15、o 14.0 ng/ml). clight passive refers to lowest quarter of cotinine concentration among nonsmokers (0-0.07 ng/ml). whincup et al. bmj. 2004;329:200-205.随访时间（年）随访时间（年）0510152000.00轻度主动吸烟轻度主动吸烟a重度被动吸烟重度被动吸烟b轻度被动吸烟轻度被动吸烟c严重冠心病发生比例被动吸烟增加冠心病发生风险被动吸烟增加冠心病发生风险athe ratio of the odds of developmen

16、t of disease in exposed persons to the odds of development of disease in nonexposed persons. adjusted for age, sex, region, physical activity, and consumption of fruits, vegetables, and alcohol. adapted from teo et al. lancet. 2006;368:647-658.比值比可信区间95被动吸烟增加急性心梗发生风险被动吸烟增加急性心梗发生风险吸烟与脑卒中吸烟与脑卒中脑核磁共振像脑

17、核磁共振像 急性缺血性脑卒中急性缺血性脑卒中goldstein et al. stroke. 2006;37:1583-1633; /stroke/whatisastroke.shtml. accessed october 19, 2007.吸烟增加急性缺血性卒中风险吸烟增加急性缺血性卒中风险aadjusted for demographic characteristics, cardiovascular risk factors, and lifestyle variables (risk factor model and keys score,

18、 education, leisure activity, body mass index, and alcohol use). bto environmental tobacco smoke.howard et al. jama. 1998;279(2):119-124.吸烟者不吸烟者且无被动吸烟b不吸烟者但有被动吸烟b戒烟者且无被动吸烟b戒烟者有被动吸烟b颈动脉内膜中层厚度增加m/3年吸烟促进颈动脉粥样硬化进展吸烟促进颈动脉粥样硬化进展athe probability of an event (developing a disease) occurring in exposed peopl

19、e compared with the probability of the event in nonexposed people. adjusted for age, follow-up period, history of diabetes, hypertension, high cholesterol levels, and relative weight (in 5 categories).colditz et al. n engl j med. 1988;318(15):937-941.1-1415-24不吸烟者25吸烟者每日吸烟量（支）吸烟者每日吸烟量（支）相对风险可信区间95吸烟

20、增加致命性和非致命性脑卒中风险吸烟增加致命性和非致命性脑卒中风险athe probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people.adjusted for age, exercise, alcohol consumption, body mass index, history of hypertension, and history of diabetes. kurth et

21、 al. stroke. 2003;34:2792-2795.不吸烟者 (n=20,339)每日吸烟量少于15支 (n=1914)每日吸烟量多于15支 (n=3265)总出血性脑卒中脑内出血蛛网膜下腔出血相对风险可信区间95吸烟增加出血性卒中风险吸烟增加出血性卒中风险atwenty-year age-adjusted mortality per 10,000 person-years for men. p.014 for trend. hart et al. stroke. 1999;30:1999-2007.15-241-1525吸烟者每日吸烟量（支）吸烟者每日吸烟量（支）死亡率/10000

22、人*年吸烟增加脑卒中死亡风险吸烟增加脑卒中死亡风险吸烟与外周血管疾病吸烟与外周血管疾病 (pvd)freund km, the framingham study: 34 years of follow-up. ann epidemiol 1993; 3:417-424吸烟增加外周血管疾病危险吸烟增加外周血管疾病危险witteman jc,. circulation 1993; 88:2156-2162wilmink tb, j vasc surg 1999; 30:1099-1105吸烟与主动脉瘤发生吸烟与主动脉瘤发生有量效关系有量效关系戒烟对心血管的益处戒烟对心血管的益处戒烟对心血管益处的病

23、理生理戒烟对心血管益处的病理生理机制机制asr=absolute rate of fibrinogen synthesis. aabstention period of 2 weeks. hunter et al. clin sci (lond). 2001;100(4):459-465.p.001p.0093.06血浆纤维蛋白原浓度g/l纤维蛋白原绝对合成速率（asr)mg/kg戒烟使纤维蛋白原下降戒烟使纤维蛋白原下降aabstention period of 17 weeks.eliasson et al. nicotine tob res. 2001;3(3):2

24、49-255.戒烟a吸烟p.026白细胞计数白细胞计数109/l戒烟使白细胞计数明显降低戒烟使白细胞计数明显降低aquit smoking for 28 days. bresumed smoking after quitting for 14 days.adp=adenosine diphosphate. adp is a platelet aggregation agonist.morita et al. j am coll cardiol. 2005;45:589-594.腺苷二磷酸（腺苷二磷酸（adp）=5.0 mol/la组ab组b血小板聚集血小板聚集 (%)020601004080时

25、间（天）时间（天）07142128nsp.01nsnsp.01戒烟使血小板聚集率下降戒烟使血小板聚集率下降hdl=high-density lipoprotein; ldl=low-density lipoprotein. aabstention period of 17 weeks. eliasson et al. nicotine tob res. 2001;3(3):249-255.低密度脂蛋白低密度脂蛋白 (mmol/l)p.001 高密度脂蛋白高密度脂蛋白 (mmol/l)吸烟戒烟a戒烟使血脂改善戒烟使血脂改善p.015吸烟戒烟a hdl/ldl 比值比值p.001吸烟戒烟a增强指数

26、增强指数 (%)baprovides an assessment of small arteriolar compliance. bthe amplitude of the reflected wave depends on the stiffness of the small vessels and large arteries and thus provides a measure of systolic arterial stiffness.cabstention period of 6 months. oren et al. angiology. 2006;57(5):564-568.

27、p.05振荡顺应性振荡顺应性 (ml/mm hg 100)ap.01吸烟戒烟c63.150.6吸烟戒烟c戒烟使动脉顺应性改善戒烟使动脉顺应性改善 a abstention period of 6 months. oren et al. angiology. 2006;57(5):564-568.心率心率 (beats/min)p.05吸烟p.05平均动脉压平均动脉压 (mm hg)吸烟戒烟a戒烟a戒烟使血液动力学改善戒烟使血液动力学改善戒烟对心血管益处的流行病学戒烟对心血管益处的流行病学1. cdc. surgeon general report 2004 2. american cancer

28、 society. guide to quitting smoking2006 肺功能改善减少咳嗽鼻窦充血呼吸急促等 3 3个月个月肺ca发生率是继续吸烟者的30-50% cadcad危险减少危险减少50%50%cadcad危险与正常不吸烟者相似危险与正常不吸烟者相似卒中危险恢复到正常不吸烟者水平1 1年年5 5 年年10 10 年年15 15 年年戒烟戒烟戒烟使冠心病风险减少戒烟使冠心病风险减少athe ratio of the odds of development of disease in exposed persons to the odds of development of di

29、sease in nonexposed persons. adjusted for sex, region, diet, alcohol, physical activity, consumption of fruits, vegetables, and alcohol.adapted from teo. lancet. 2006;368:647-658.比值比可信区间95戒烟使急性心梗风险降低戒烟使急性心梗风险降低生存率生存率 (%)100806040200023456789101112时间（年）时间（年）hasdai. n engl j med. 1997;336(11):755-761.

30、戒烟者持续吸烟者戒烟使冠状动脉介入治疗后死亡率下降戒烟使冠状动脉介入治疗后死亡率下降adapted from van domburg et al. j am coll cardiol. 2000;36(3):878-883.生存概率生存概率 (%)05101520年年不吸烟者持续吸烟者100806040200戒烟者戒烟使冠状动脉旁路移植术后死亡率减低戒烟使冠状动脉旁路移植术后死亡率减低peters et al. j am coll cardiol. 1995;26(5):1287-1292.p=.040生存时间（年）生存时间（年）0204060801000231戒烟者吸烟生存率戒烟使心律失常死

31、亡风险减少戒烟使心律失常死亡风险减少 aabstention period of 3 years. hallstrom et al. n engl j med. 1986;314:271-275.3年内发生率年内发生率 (%)p=.038心脏骤停反复发作心脏骤停反复发作2719051015202530吸烟者戒烟者a戒烟使心脏骤停风险减低戒烟使心脏骤停风险减低jonason et al. acta med scand. 1987;221:253-260.年年累积静息痛累积静息痛 (%)3020100p=.0492716543戒烟吸烟戒烟使外周血管疾病症状改善戒烟使外周血管疾病症状改善athe p

32、robability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people. adjusted for age and treatment assignment.robbins et al. ann intern med. 1994;120(6):458-462.不吸烟者戒烟者吸烟者(20支/日)吸烟者(20 支/日）p .0001(趋势趋势)相对风险可信区间95戒烟使卒中风险降低戒烟使卒中风险降低全因死亡降低约15-20%cvd死亡降低约25-35%1。kawachi, 1993. 2. lievre, 2000. 3. vrcer, 2003戒烟戒烟1 1降压降压2 2降胆固醇降胆固醇l3l3 戒烟戒烟1 10 0. .1 10 0. .4 40 0. .7 71 1. .0 01 1. .3 31 1. .6 61 1. .9 9全因死亡全因死亡降胆固醇降胆固醇3 3降压降压2 2cvdcvd死亡死亡戒烟、降压、降胆固醇戒烟、降压、降胆固醇对无对无cvd史者死亡的影响史者死亡的影响全因死亡降低约12-35%戒烟所致的风险