Secondhand smoke exposure, pulmonary function, and cardiovascular mortality
Secondhand smoke exposure, pulmonary function, and cardiovascular mortality
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DOI：
10.1016/j.annepidem.2006.10.008
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发表时间：
2007-05-01
影响因子：
5.6
通讯作者：
Tager, Ira B.
中科院分区：
文献类型：
--
作者：
Eisner, Mark D.;Wang, Yue;Tager, Ira B.
目的：心血管疾病和阻塞性肺病是全球主要的死亡原因。尽管如此，二手烟（SHS）暴露对肺功能和心血管疾病的影响仍然不确定。我们的目标是阐明基线SHS暴露和肺功能下降和心血管死亡率的风险之间的关联在一段时间的近decades.METHODS：我们使用的数据从纵向队列研究的1,057名老年人研究基线SHS暴露和肺功能下降和心血管死亡率的风险之间的关联。SHS暴露对心血管死亡率的影响可能是通过其对FEV的影响以及通过测量FEV 1捕获的生物过程来介导的。或者，SHS的作用可能是由基线心血管疾病状态介导的，这反映了传统心血管危险因素的综合作用。为了正确估计SHS和FEV对心血管死亡率的影响，我们使用了边际结构模型（MSM），该模型考虑了FEV的中介作用，以及因果通路中的基线心血管疾病。结果：在纵向多变量分析中，终生累积家庭和工作SHS暴露与FEV的更大下降相关，（-15 mL/s; 95% CI，每10年累积暴露分别为-29至-1.3 mL/s和-41 mL/s; 95% CI，每10年累积暴露为-55至-28 mL/s）。在传统的多变量分析中，（HR，1.10/10年暴露; 95% CI，0.99 - 1.24）和MSM的FEV 1（HR，1.06; 95% CI，0.95 - 1.19）和基线心血管疾病（基线无心血管疾病受试者的HR为1.39; 95%CI为1.17 - 1.66）。考虑到混杂因素和FEV的介导作用，和基线心血管疾病。《流行病学年鉴》2007;17：364-373。(C)2007年爱思唯尔公司All rights reserved.
PURPOSE: Cardiovascular disease and obstructive lung disease are leading global causes of death. Despite this, the impact of secondhand smoke (SHS) exposure on pulmonary function and cardiovascular disease remains uncertain. Our goal was to elucidate the association between baseline SHS exposure and the risk of lung function decline and cardiovascular mortality over a period of nearly a decade.METHODS: We used data from a longitudinal cohort study of 1,057 older adults to study the association between baseline SHS exposure and the risk of lung function decline and cardiovascular mortality. The effect of SHS exposure on cardiovascular mortality may be mediated by its influence on FEV, and biological processes captured by measurement of FEV1. Alternatively, the effect of SHS may be mediated by baseline cardiovascular disease status, which reflects the combined effects of traditional cardiovascular risk factors. To correctly estimate the effect of SHS and FEV, on cardiovascular mortality, we used marginal structural models (MSMs) that took into account the mediating effects of FEV, and baseline cardiovascular disease in the causal pathway.RESULTS: In longitudinal multivariate analyses, lifetime cumulative home and work SHS exposure were associated with a greater decline of FEV, (-15 mL/s; 95% CI, -29 to -1.3 mL/s and -41 mL/s; 95% CI, -55 to -28 mL/s per 10-year cumulative exposure, respectively). Lifetime home SHS exposure was associated with a greater risk of cardiovascular mortality in both conventional multivariate analysis (HR, 1.10 per 10 years of exposure; 95% CI, 0.99 to 1.24) and the MSM for FEV1 (HR, 1.06; 95% CI, 0.95 to 1.19) and baseline cardiovascular disease (HR for subjects with no baseline cardiovascular disease, 1.39; 95% CI, 1.17 to 1.66).CONCLUSIONS: Lifetime SHS exposure appears to result in a greater decline in lung function and risk of cardiovascular mortality, taking into account confounders and the mediating effect of FEV, and baseline cardiovascular disease. Ann Epidemiol 2007;17:364-373. (C) 2007 Elsevier Inc. All rights reserved.