Cigarette smoking exposure and heart failure risk in older adults: The Health, Aging, and Body Composition Study
Cigarette smoking exposure and heart failure risk in older adults: The Health, Aging, and Body Composition Study
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DOI：
10.1016/j.ahj.2012.05.013
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发表时间：
2012-08-01
影响因子：
4.8
通讯作者：
Butler, Javed
中科院分区：
文献类型：
--
作者：
Gopal, Deepa M.;Kalogeropoulos, Andreas P.;Butler, Javed
背景 尽管有证据表明吸烟与心力衰竭 (HF) 存在关联，但老年人终生吸烟暴露与心力衰竭之间的关联以及当前和既往吸烟者之间这种关联的强度尚不清楚。 方法 我们对 2,125 名健康、衰老和身体成分研究参与者（年龄 73.6 +/- 2.9 岁，69.7% 女性，54.2%）的吸烟状况、暴露年数和心力衰竭事件风险之间的关联进行了研究。结果在开始时，54.8% 的参与者是非吸烟者，34.8% 是过去吸烟者，10.4% 是当前吸烟者。在随访期间（中位 9.4 年），非吸烟者的心力衰竭发病率为每 1,000 人年 11.4 例，既往吸烟者为 15.2 例（风险比 [HR] 与非吸烟者相比 1.33，95% CI 1.01-1.76，P = 0.045），当前吸烟者为 21.9 例（HR 1.93，95% CI） 1.30-2.84，P = .001）。在调整心力衰竭风险因素、冠状动脉事件和死亡竞争风险后，观察到暴露包年数与心力衰竭风险之间的剂量效应关联（HR 1.09，95% CI 1.05-1.14，P < 0.001/10包年）。当前吸烟者的心力衰竭风险不受暴露年数的影响。在过去的吸烟者中，在完全调整的模型中，1至11包年的HF风险比为1.05（95% CI 0.64-1.72），12至35包年的HF风险比为1.23（95% CI 0.82-1.83），> 35包年的暴露为1.64（95% CI 1.11-2.42）（P < .001（趋势））与不吸烟者相比。结论 在老年人中，当前和过去吸烟都会增加心衰风险。对于目前的吸烟者来说，无论接触的包年数如何，这种风险都很高，而对于过去的吸烟者来说，存在剂量效应关联。 （Am Heart J 2012；164：236-42。）
Background Although there is evidence linking smoking and heart failure (HF), the association between lifetime smoking exposure and HF in older adults and the strength of this association among current and past smokers is not well known.Methods We examined the association between smoking status, pack-years of exposure, and incident HF risk in 2,125 participants of the Health, Aging, and Body Composition Study (age 73.6 +/- 2.9 years, 69.7% women, 54.2% whites) using proportional hazard models.Results At inception, 54.8% of participants were nonsmokers, 34.8% were past smokers, and 10.4% were current smokers. During follow-up (median 9.4 years), HF incidence was 11.4 per 1,000 person-years in nonsmokers, 15.2 in past smokers (hazard ratio [HR] vs nonsmokers 1.33, 95% CI 1.01-1.76, P = .045), and 21.9 in current smokers (HR 1.93, 95% CI 1.30-2.84, P = .001). After adjusting for HF risk factors, incident coronary events, and competing risk for death, a dose-effect association between pack-years of exposure and HF risk was observed (HR 1.09, 95% CI 1.05-1.14, P < .001 per 10 pack-years). Heart failure risk was not modulated by pack-years of exposure in current smokers. In past smokers, HR for HF was 1.05 (95% CI 0.64-1.72) for 1 to 11 pack-years, 1.23 (95% CI 0.82-1.83) for 12 to 35 pack-years, and 1.64 (95% CI 1.11-2.42) for > 35 pack-years of exposure in fully adjusted models (P < .001 for trend) compared with nonsmokers.Conclusions In older adults, both current and past cigarette smoking increase HF risk. In current smokers, this risk is high irrespective of pack-years of exposure, whereas in past smokers, there was a dose-effect association. (Am Heart J 2012; 164: 236-42.)