烟和心血管疾病课件.ppt

1、烟和心血管疾病烟和心血管疾病中国NEHNS IV2021/1/122由吸烟引起死亡的前三位疾病：国外资料为：COPD冠心病肺Ca国内资料为：COPD肺Ca冠心病1.Surgeoen Generals Report.Health Consequences of Smoking;2004.2.J Natl Cancer Inst.1993;85(24):1994.3.Crane.Cancer Epidemiol Biomarkers Prev.1996;5(8):639.4.Miligi.Am J Ind Med.1999;36(1):60.5.Roman.Cerebrovasc Dis,2005

2、;20(Suppl 2):91.6.Willigendael.J Vasc Surg.2004;40:1158.7.Yang.BMJ.1999;319:1432021/1/123Lavi et al.Circulation.2007;115:2621-2627;http:/www.texasheartinstitute.org/HIC/Topics/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2021/1/124Sambola et al.Circulation.2003;107:973-977.Factor Xa(FXa)

3、pmol/L/minP=.0032172830100200300400吸烟者吸烟前（2支烟）吸烟者吸烟后(2支烟)2021/1/125Barua et al.Circulation.2001;104:1905-1910.50000不吸烟者吸烟者4000300020001000NO浓度浓度(nmol/L)P.0001126636132021/1/126Zeiher 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

4、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2021/1/127Lavi et al.Circulation.2007;115:2621-2627.P=.03604530150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2021/1/128Lavi 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/L2

5、021/1/129ns=not significant.a Unless marked as“ns,”differences for each 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5.62.53.2

6、3.64.04.44.85.2nsnsnsnsnsnsnsnsnsns天天2021/1/1210异构前列腺素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10

7、00900800700600500400300吸烟者不吸烟者自由异构前列腺素自由异构前列腺素F2pmol/L酯化异构前列腺素酯化异构前列腺素F2pmol/L2021/1/12112021/1/12122021/1/12132021/1/1214Waters 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2021/1/1215aThe probability of an event(developing a disease)occurrin

8、g 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952021/1/1216aThe ratio of the odds of development of disease in exposed persons to the odds of development of disease in none

9、xposed persons.Teo.Lancet.2006;368:647-658.风险比可信区间952021/1/1217Y usuf S et al.Lancet.2004;364:937-52OR (99%CI)2021/1/1218a The probability of an event(developing a disease)occurring in exposed people compared with the probability of the event in nonexposed people.Adjusted for age.Willett et al.N Eng

10、l 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952021/1/1219aThe probability of an event(developing a disease)occurring in exposed people compared with the probability of the event in nonexposed people.Adjusted for age.Wannamethee et al.Circulation.1995;91:1749-1756.1.02.30.01.02.03.04.0不吸烟者

11、吸烟者相对风险可信区间952021/1/1220aThe probability of an event(developing a disease)occurring in exposed people compared with the probability of the event in nonexposed people.Adjusted for the baseline 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

12、)相对风险可信区间950.01.02.03.04.0不吸烟者戒烟者吸烟者2021/1/12212021/1/1222Adjusted for age,systolic blood pressure,diastolic blood pressure,total cholesterol,HDL cholesterol,FEV,height,preexisting CAD,body mass index,triglycerides,white cell count,diabetes,physical activity,alcohol intake,and social class.aLight ac

13、tive refers to men smoking 1-9 cigarettes a day.bHeavy passive refers to upper three quarters of cotinine concentration combined(0.8 to 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）051015

14、2000.050.100.150.20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2021/1/1223aThe ratio of the odds of development 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

15、.Adapted from Teo et al.Lancet.2006;368:647-658.比值比可信区间952021/1/12242021/1/1225脑核磁共振像脑核磁共振像 急性缺血性脑卒中急性缺血性脑卒中Goldstein et al.Stroke.2006;37:1583-1633;http:/www.ucihs.uci.edu/stroke/whatisastroke.shtml.Accessed October 19,2007.2021/1/1226aAdjusted for demographic characteristics,cardiovascular risk fa

16、ctors,and lifestyle variables(risk factor model and Keys score,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2021/1/1227aThe probability of an event(developi

17、ng a disease)occurring in exposed people 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

18、日吸烟量（支）吸烟者每日吸烟量（支）相对风险可信区间952021/1/1228aThe 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

19、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952021/1/1229aTwenty-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人*年2021/1/12302021/1/

20、1231Freund KM,The Framingham Study:34 years of follow-up.Ann Epidemiol 1993;3:417-4242021/1/1232Witteman JC,.Circulation 1993;88:2156-2162Wilmink TB,J Vasc Surg 1999;30:1099-11052021/1/12332021/1/12342021/1/1235ASR=absolute rate of fibrinogen synthesis.aAbstention period of 2 weeks.Hunter et al.Clin

21、 Sci(Lond).2001;100(4):459-465.P.001P.00116.124.12.493.06血浆纤维蛋白原浓度g/L纤维蛋白原绝对合成速率（ASR)mg/kg2021/1/1236aAbstention period of 17 weeks.Eliasson et al.Nicotine Tob Res.2001;3(3):249-255.戒烟a吸烟P.026白细胞计数白细胞计数109/L2021/1/1237aQuit smoking for 28 days.bResumed smoking after quitting for 14 days.ADP=adenosin

22、e 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时间（天）时间（天）07142128NSP.01NSNSP.012021/1/1238HDL=high-density lipoprotein;LDL=low-density lipoprotein.aAbstention period of 17 weeks.Eliasson et a

23、l.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aP.015吸烟戒烟a HDL/LDL 比值比值P.001吸烟戒烟a2021/1/1239增强指数增强指数(%)baProvides an assessment of small arteriolar compliance.bThe amplitude of the reflected wave depends on the stiffness of the small vessels and large arteries

24、 and thus provides a measure of systolic arterial stiffness.cAbstention period of 6 months.Oren et al.Angiology.2006;57(5):564-568.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c2021/1/1240 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

25、压(mm Hg)吸烟戒烟a戒烟a2021/1/12412021/1/12421.CDC.Surgeon General Report 2004 2.American Cancer 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%CAD危险减少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2021/1/1243aThe ratio of the odds of develo

26、pment of disease in exposed persons to the odds of development of disease 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952021/1/1244生存率生存率(%)100806040200023456789101112时间（年）时间

27、（年）Hasdai.N Engl J Med.1997;336(11):755-761.戒烟者持续吸烟者2021/1/1245Adapted 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2021/1/1246Peters 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2021/1/1247 aAbst

28、ention 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a2021/1/1248Jonason 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2021/1/1249aThe probability of an event(developing a disease)occurring in

29、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952021/1/1250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

30、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2021/1/1251全因死亡降低约12-35%戒烟所致的风险降低最大戒烟戒烟1 1降压降压2a 2a 降压降压2b 2b 降胆固醇降胆固醇4 40.10.40.71.01.31.61.9降胆固醇降胆固醇3 31.Critchley,2003.2.BPLTTC,2003.3.Vrercer,2003.4.CTT,2005全因死亡全因死亡2021/1/1252平均

31、每挽救一个生命年（人年）的成本平均每挽救一个生命年（人年）的成本:Benowitz,Prog Cardiovasc Dis,2003;46:912021/1/1253血小板体积减小血小板环磷酸腺苷反应增强，促使前列腺素E1 发生腺苷酸环化吸烟导致的血小板聚集减少,Twardella et al.Eur Heart J.2004;25:2101-2108;Morita et al.J Am Coll Cardiol.2005;45:589-594;Oren et al.Angiology.2006;57:564-568;Terres et al.Am J Med.1994;97:242-249;

32、Nilsson et al.J Int Med.1996;240:189-194;Peters et al.J Am Coll Cardiol.1995;26:1287-1292;Rea et al.Ann Intern Med.2002;137:494-500;Hasdai et al.N Engl J Med.1997;336:755-761;van Domburg et al.J Am Coll Cardiol.2000;36:878-883;Bakhru et al.PLoS Med.2005;2:e160;Eliasson et al.Nicotine Tob Res.2001;3:249-255;Hunter et al.Clin Sci.2001;100:459-465;Wannamethee et al.JAMA.1995;274:155-160.2021/1/12542021/1/12552021/1/1256