Impact of Cigarette Smoking and Its Interaction with Hypertension and Diabetes on Cognitive Function in Older Americans.
Impact of Cigarette Smoking and Its Interaction with Hypertension and Diabetes on Cognitive Function in Older Americans.
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DOI：
10.3233/jad-220647
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发表时间：
2022
影响因子：
4
通讯作者：
Parikh, Neal S.
中科院分区：
文献类型：
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作者：
Restifo, Daniel;Zhao, Chen;Kamel, Hooman;Iadecola, Costantino;Parikh, Neal S.
吸烟对大脑健康的有害影响是众所周知的。评估吸烟是否与高血压和糖尿病协同影响认知能力。我们使用美国国家健康和营养检查调查进行了横断面分析。参与者接受了血清可替宁（一种经过验证的吸烟/暴露生物标志物）的检测，并进行了标准化的血压和血红蛋白A1 c测量。参与者接受了4项认知测试：数字符号替换（DSST），动物流畅性，即时回忆和延迟回忆。调整人口统计学和混杂因素的多变量线性回归模型评估了可替宁与认知的相关性。相互作用检验评价了高血压、糖尿病及其连续测量（收缩压和血红蛋白A1 c）的效应改变。在3,007名参与者中，平均年龄为69.4岁; 54%为女性。使用可替宁水平，14.9%的参与者被归类为活跃吸烟者。当将可替宁建模为连续变量（β，−0.70; 95%CI，−1.11，−0.29; P<0.01）和将参与者归类为活跃吸烟者（β，−5.63; 95%CI，−9.70，−1.56; P<0.01）时，较高的可替宁水平与较差的DSST表现相关。可替宁与流畅性或记忆力无关。高血压和糖尿病的影响修改是不存在的，除了可替宁与更差的即时回忆在较低的血压。吸烟和二手暴露生物标志物水平较高与多领域测试中认知表现较差相关。总的来说，可替宁与认知的关系并不取决于高血压或糖尿病或被高血压或糖尿病放大;无论这些合并症如何，吸烟都对大脑健康有害。
The detrimental impact of tobacco smoking on brain health is well recognized. To evaluate whether smoking acts synergistically with hypertension and diabetes to influence cognitive performance. We performed a cross-sectional analysis using the US National Health and Nutrition Examination Survey. Participants were tested for serum cotinine, a validated cigarette smoking/exposure biomarker, and had standardized blood pressure and hemoglobin A1c measurements. Participants were administered 4 cognitive tests: Digit Symbol Substitution (DSST), Animal Fluency, Immediate Recall, and Delayed Recall. Multivariable linear regression models adjusted for demographics and confounders evaluated the association of cotinine with cognition. Interaction testing evaluated effect modification by hypertension, diabetes, and their continuous measures (systolic blood pressure and hemoglobin A1c). For 3,007 participants, mean age was 69.4 years; 54% were women. Using cotinine levels, 14.9% of participants were categorized as active smokers. Higher cotinine levels were associated with worse DSST performance when modeling cotinine as a continuous variable (β, −0.70; 95% CI, −1.11, −0.29; P<0.01) and when categorizing participants as active smokers (β, −5.63; 95% CI, −9.70, −1.56; P<0.01). Cotinine was not associated with fluency or memory. Effect modification by hypertension and diabetes were absent, except that cotinine was associated with worse Immediate Recall at lower blood pressures. Higher levels of a smoking and secondhand exposure biomarker were associated with worse cognitive performance on a multidomain test. Overall, the relationship of cotinine with cognition was not contingent on or amplified by hypertension or diabetes; smoking is detrimental for brain health irrespective of these comorbidities.