吸烟与心血管疾病课件.ppt

1、吸烟与心血管疾病中国NEHNS IV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;2019.2.J Natl Cancer Inst.1993;85(24):1994.3.Crane.Cancer Epidemiol Biomarkers Prev.2019;5(8):639.4.Miligi.Am J Ind Med.2019;36(1):6

2、0.5.Roman.Cerebrovasc Dis,2019;20(Suppl 2):91.6.Willigendael.J Vasc Surg.2019;40:1158.7.Yang.BMJ.2019;319:143Lavi et al.Circulation.2019;115:2621-2627;texasheartinstitute.org/HIC/Topics/Diag/diangio.cfm.Accessed June 14,2019.右冠状动脉粥样硬化右冠状动脉粥样硬化Sambola et al.Circulation.2019;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)Barua et al.Circulation.2019;104:1905-1910.50000不吸烟者吸烟者4000300020001000NO浓度浓度(nmol/L)P.000112663613Zeiher et al.Circulation.2019;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

4、血管舒张功能流量调节的内皮血管舒张功能Lavi et al.Circulation.2019;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Lavi et al.Circulation.2019;115:2621-2627;Stewart et al.Circulation.2019;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/Lns=not significant.a Unless marked as“ns,

5、”differences for each value between groups were statistically significant at a level of P.05.Schmid et al.Thromb Res.2019;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5.62.53.23.64.04.44.85.2nsnsnsnsnsnsnsnsnsns天天异构前列腺素F2 水平是体

6、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.2019;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F2pmol/L酯化异构前列腺

7、素酯化异构前列腺素F2pmol/L吸烟与心血管疾病的流行病学吸烟与冠心病(CAD)Waters et al.Circulation.2019;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aThe probability of an event(developing a disease)occurring in exposed people compared with the probability of the event in nonexposed people.Adjusted

8、 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95aThe ratio of the odds of development of disease in exposed persons to the odds of development of disease in nonexposed persons.Teo.Lancet.2019;368:647-658.风险比可信区间95Y usuf S et al.Lancet.2019;364:937-52OR (99%CI)a Th

9、e 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 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95aThe probability of an event(developing a disease)occurring in expos

10、ed people compared with the probability of the event in nonexposed people.Adjusted for age.Wannamethee et al.Circulation.2019;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95aThe probability of an event(developing a disease)occurring in exposed people compared with the probability of the event in

11、 nonexposed people.Adjusted for the baseline variables significantly associated with each end point.Hasdai et al.N Engl J Med.2019;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被动吸烟与冠心病Adjusted for age,systolic blood pressure,diastolic blood pressure,total cholesterol,HDL cholesterol,FEV

12、,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 to 14.0 ng/mL).cLight passiv

13、e refers to lowest quarter of cotinine concentration among nonsmokers(0-0.07 ng/mL).Whincup et al.BMJ.2019;329:200-205.随访时间（年）随访时间（年）0510152000.050.100.150.20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aThe ratio of the odds of development of disease in exposed persons to the odds of development

14、 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.2019;368:647-658.比值比可信区间95吸烟与脑卒中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.2019;37:1583-1633;ucihs.uci.edu/stroke/whatisastroke.shtm

15、l.Accessed October 19,2019.aAdjusted for demographic characteristics,cardiovascular risk factors,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.2019;279(2):119-124.吸烟者不吸烟者且无被动吸烟b不吸

16、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,follow-up period,history of diabetes,hypertension,high cholesterol levels,and relative weight(in 5

17、 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95aThe 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

18、 mass index,history of hypertension,and history of diabetes.Kurth et al.Stroke.2019;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95aTwenty-year age-adjusted mortality per 10,000 person-years for men.P.014 for trend.Hart et al.Stroke.2019;30:2019-2019.15-24

19、1-1525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;3:417-424Witteman JC,.Circulation 1993;88:2156-2162Wilmink TB,J Vasc Surg 2019;30:1099-1105戒烟对心血管的益处戒烟对心血管益处的病理生理机制ASR=absolute rate of fibrinogen synthesis.aAbstention perio

20、d of 2 weeks.Hunter et al.Clin Sci(Lond).2019;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/kgaAbstention period of 17 weeks.Eliasson et al.Nicotine Tob Res.2019;3(3):249-255.戒烟a吸烟P.026白细胞计数白细胞计数109/LaQuit smoking for 28 days.bResumed smoking after quitting for 14 days.ADP=

21、adenosine diphosphate.ADP is a platelet aggregation agonist.Morita et al.J Am Coll Cardiol.2019;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.01HDL=high-density lipoprotein;LDL=low-density lipoprotein.aAbstention period of 17 weeks.Eliasson et al.N

22、icotine Tob Res.2019;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a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 and thus prov

23、ides a measure of systolic arterial stiffness.cAbstention period of 6 months.Oren et al.Angiology.2019;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c a Abstention period of 6 months.Oren et al.Angiology.2019;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戒烟对心血管益处的

24、流行病学1.CDC.Surgeon General Report 2019 2.American Cancer Society.Guide to Quitting Smoking2019 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aThe ratio of the odds of development of disease in exposed persons

25、 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.2019;368:647-658.比值比可信区间95生存率生存率(%)100806040200023456789101112时间（年）时间（年）Hasdai.N Engl J Med.2019;336(11):755-761.戒烟

26、者持续吸烟者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Peters et al.J Am Coll Cardiol.2019;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 aAbstention period of 3 years.Hallstrom et al.N Engl J Med.1986;314:271-275.3年内发生率年内

27、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aJonason 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 and t

28、reatment 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,2019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 2CVDC

29、VD死亡死亡全因死亡降低约12-35%戒烟所致的风险降低最大戒烟戒烟1 1降压降压2a2a 降压降压2b2b 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,2019.2.BPLTTC,2019.3.Vrercer,2019.4.CTT,2019全因死亡全因死亡平均每挽救一个生命年（人年）的成本平均每挽救一个生命年（人年）的成本:Benowitz,Prog Cardiovasc Dis,2019;46:91Twardella et al.Eur Heart J.2019;25:2101-2108;Morita et al.J Am

30、Coll Cardiol.2019;45:589-594;Oren et al.Angiology.2019;57:564-568;Terres et al.Am J Med.1994;97:242-249;Nilsson et al.J Int Med.2019;240:189-194;Peters et al.J Am Coll Cardiol.2019;26:1287-1292;Rea et al.Ann Intern Med.2019;137:494-500;Hasdai et al.N Engl J Med.2019;336:755-761;van Domburg et al.J Am Coll Cardiol.2000;36:878-883;Bakhru et al.PLoS Med.2019;2:e160;Eliasson et al.Nicotine Tob Res.2019;3:249-255;Hunter et al.Clin Sci.2019;100:459-465;Wannamethee et al.JAMA.2019;274:155-160.