Smoking reduction, smoking cessation, and incidence of fatal and non-fatal myocardial infarction in Denmark 1976-1998: a pooled cohort study
Smoking reduction, smoking cessation, and incidence of fatal and non-fatal myocardial infarction in Denmark 1976-1998: a pooled cohort study
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DOI：
10.1136/jech.57.6.412
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发表时间：
2003-06-01
影响因子：
6.3
通讯作者：
Prescott, E
中科院分区：
文献类型：
--
作者：
Godtfredsen, NS;Osler, M;Prescott, E
目的：分析在调整已确定的心血管危险因素后，戒烟和戒烟对心肌梗死发病率的影响。设计：前瞻性队列研究，记录与死亡率和医院登记的关联。以连续重度吸烟者(每天吸烟量大于或等于5支)为参照，用COX比例风险分析检验个体吸烟改变与心肌梗死的关系。研究背景：在丹麦哥本哈根进行的三项人群研究的汇总数据。参与者：在两次检查中有完整吸烟习惯的10 956名男性和8467名女性在首次住院或死于心肌梗死的第二次检查后进行了随访。平均随访时间为13.8年。主要结果：在第一次和第二次检查之间，共有643名重度吸烟者在没有戒烟的情况下减少了至少50%的日常烟草摄入量，1379名参与者戒烟。在随访期间，1658名男性和521名女性经历了致命或非致命的心肌梗死。在调整了心血管危险因素后，戒烟的人患心肌梗死的风险降低，危险比为0.71(95%可信区间为0.59至0.85)。减少吸烟与降低心肌梗死风险无关，危险比为1.15(95%可信区间为0.94至1.40)。在以不同方式控制基线疾病后，这些关联保持不变。结论：健康人戒烟可降低随后发生心肌梗死的风险，而这项研究没有提供减少吸烟量有益的证据。
Objective: To analyse the effects of smoking reduction and smoking cessation on incidence of myocardial infarction after adjustment for established cardiovascular risk factors.Design: Prospective cohort study with record linkage to mortality and hospital registers. The association of individual change in smoking with myocardial infarction was examined in Cox proportional hazard analyses with continuous heavy smokers (greater than or equal to5 cigarettes/day) as reference.Setting: Pooled data from three population studies conducted in Copenhagen, Denmark.Participants: 10 956 men and 8467 women with complete information on smoking habits at two examinations five to ten years apart were followed up from the second examination for a first hospital admission or death from myocardial infarction. Mean duration of follow up was 13.8 years.Main results: A total of 643 participants who were heavy smokers at baseline reduced their daily tobacco consumption by at least 50% without quitting between first and second examination, and 1379 participants stopped smoking. During follow up 1658 men and 521 women experienced a fatal or non-fatal myocardial infarction. After adjustment for cardiovascular risk factors, people who stopped smoking had a decreased risk of myocardial infarction, hazard ratio 0.71 (95% confidence intervals 0.59 to 0.85). Smoking reduction was not associated with reduced risk of myocardial infarction, hazard ratio 1.15 (95% confidence intervals 0.94 to 1.40). These associations remained unchanged after controlling for baseline illness in different ways.Conclusions: Smoking cessation in healthy people reduces the risk of a subsequent myocardial infarction, whereas this study provides no evidence of benefit from reduction in the amount smoked.