CIGARETTE-SMOKING AND RISK OF STROKE IN MIDDLE-AGED WOMEN
CIGARETTE-SMOKING AND RISK OF STROKE IN MIDDLE-AGED WOMEN
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DOI：
10.1056/nejm198804143181501
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发表时间：
1988-04-14
影响因子：
158.5
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
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作者：
COLDITZ, GA;BONITA, R;HENNEKENS, CH
众所周知，吸烟与男性血栓性和出血性中风的风险增加有关。为了检验女性之间的这种关联，我们在 1976 年对 118,539 名 30 至 55 岁且无冠心病、中风和癌症的女性进行了一项前瞻性队列研究，检查了中风发病率与吸烟的关系。在八年的随访期间（908,447 人年），我们发现了 274 例中风，其中 71 例为蛛网膜下腔出血，26 例为脑内出血。出血、122 例血栓栓塞性中风以及 55 例信息不足以进行分类的中风。每天吸烟的数量与中风的风险呈正相关。与从不吸烟的女性相比，每天吸 1 至 14 支烟的女性的年龄调整相对风险为 2.2（95% 置信区间，1.5 至 3.3），而每天吸 25 支或以上的女性的相对风险为 3.7（95% 置信区间，2.7 至 5.1）。对于后一组女性，与从不吸烟的女性相比，蛛网膜下腔出血的相对风险为 9.8（95% 置信区间，5.3 至 17.9）。对相对体重、高血压、糖尿病、高胆固醇史、既往使用口服避孕药、绝经后雌激素治疗和酒精摄入的影响进行调整，并没有明显改变吸烟与中风发病率之间的关联。这些前瞻性数据支持年轻和中年女性吸烟与中风之间存在很强的因果关系。
It is known that cigarette smoking is associated with increased risk of both thrombotic and hemorrhagic stroke among men. To test for such an association among women, we examined the incidence of stroke in relation to cigarette smoking in a prospective cohort study of 118,539 women 30 to 55 years of age and free from coronary heart disease, stroke, and cancer in 1976. During eight years of follow-up (908,447 person-years), we identified 274 strokes, comprising 71 subarachnoid hemorrhages, 26 intracerebral hemorrhages, 122 thromboembolic strokes, and 55 strokes about which information was insufficient to permit classification. The number of cigarettes smoked per day was associated positively with the risk of stroke. Compared with the women who had never smoked, those who smoked 1 to 14 cigarettes per day had an age-adjusted relative risk of 2.2 (95 percent confidence interval, 1.5 to 3.3), whereas those who smoked 25 or more cigarettes per day had a relative risk of 3.7 (95 percent confidence interval, 2.7 to 5.1). For women in this latter group, the relative risk of subarachnoid hemorrhage was 9.8 (95 percent confidence interval, 5.3 to 17.9), as compared with those who had never smoked. Adjustment for the effects of relative weight, hypertension, diabetes, history of high cholesterol, previous use of oral contraceptives, postmenopausal estrogen therapy, and alcohol intake did not appreciably alter the association between cigarette use and incidence of stroke. These prospective data support a strong causal relation between cigarette smoking and stroke among young and middle-aged women.