美国范德比尔特大学医学中心Meredith S. Duncan课题组近日取得一项新成果。他们探讨了戒烟与心血管疾病风险的关系。相关论文发表在2019年8月20日出版的《美国医学会杂志》上。

该课题组前瞻性收集了弗雷明翰心脏研究的数据，在这项回顾性分析中，原始参与者3805人（1954-1958），后续参与者4965人（1971-1975），所有参与者入组前均没有心血管疾病（CVD，包括心肌梗死、中风、心力衰竭或心血管死亡），所有参与者均随访至2015年12月。其中重度吸烟者定义为每天至少抽一包烟，持续20年及以上。

8770名参与者的平均年龄为42.2岁，45%为男性，5308名吸烟，平均烟龄17.2年，其中2371名为重度吸烟者（406名已戒烟，1965名未戒）。中位随访26.4年后，共有2435例参与者发生CVD事件，其中重度吸烟者1095例。戒烟5年内的参与者每1000人年CVD的发病率为6.94%，显著低于未戒烟者（11.56%），风险比为0.61；戒烟10-15年后每1000人年CVD的发病率为6.31%，仍高于从未吸烟者（5.09%），风险比为1.25。

在重度吸烟者中，戒烟5年内与未戒烟者相比CVD风险显著降低，但仍然高于从未吸烟者。

据悉，重度吸烟者戒烟后CVD风险的时间进程尚不清楚。风险计算器认为只有5年。

附：英文原文

Title: Association of Smoking Cessation With Subsequent Risk of Cardiovascular Disease

Author: Meredith S. Duncan, Matthew S. Freiberg, Robert A. Greevy Jr, Suman Kundu,Ramachandran S. Vasan,Hilary A. Tindle

Issue&Volume: Vol 322 No 7

Abstract:

Importance  The time course of cardiovascular disease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years.

Objective  To evaluate the association between years since quitting smoking and incident CVD.

Design, Setting, and Participants  Retrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination in 1954-1958; offspring cohort: attending their first examination in 1971-1975) who were followed up through December 2015.

Exposures  Time-updated self-reported smoking status, years since quitting, and cumulative pack-years.

Main Outcomes and Measures  Incident CVD (myocardial infarction, stroke, heart failure, or cardiovascular death). Primary analyses included both cohorts (pooled) and were restricted to heavy ever smokers (≥20 pack-years).

Results  The study population included 8770 individuals (original cohort: n = 3805; offspring cohort: n = 4965) with a mean age of 42.2 (SD, 11.8) years and 45% male. There were 5308 ever smokers with a median 17.2 (interquartile range, 7-30) baseline pack-years, including 2371 heavy ever smokers (406 [17%] former and 1965 [83%] current). Over 26.4 median follow-up years, 2435 first CVD events occurred (original cohort: n = 1612 [n = 665 among heavy smokers]; offspring cohort: n = 823 [n = 430 among heavy smokers]). In the pooled cohort, compared with current smoking, quitting within 5 years was associated with significantly lower rates of incident CVD (incidence rates per 1000 person-years: current smoking, 11.56 [95% CI, 10.30-12.98]; quitting within 5 years, 6.94 [95% CI, 5.61-8.59]; difference, −4.51 [95% CI, −5.90 to −2.77]) and lower risk of incident CVD (hazard ratio, 0.61; 95% CI, 0.49-0.76). Compared with never smoking, quitting smoking ceased to be significantly associated with greater CVD risk between 10 and 15 years after cessation in the pooled cohort (incidence rates per 1000 person-years: never smoking, 5.09 [95% CI, 4.52-5.74]; quitting within 10 to <15 years, 6.31 [95% CI, 4.93-8.09]; difference, 1.27 [95% CI, −0.10 to 3.05]; hazard ratio, 1.25 [95% CI, 0.98-1.60]).

Conclusions and Relevance  Among heavy smokers, smoking cessation was associated with significantly lower risk of CVD within 5 years relative to current smokers. However, relative to never smokers, former smokers’ CVD risk remained significantly elevated beyond 5 years after smoking cessation.

DOI: 10.1001/jama.2019.10298

Source: https://jamanetwork.com/journals/jama/article-abstract/2748507