Cigarette Smoking and Competing Risks for Fatal and Nonfatal Cardiovascular Disease Subtypes Across the Life Course.
Cigarette Smoking and Competing Risks for Fatal and Nonfatal Cardiovascular Disease Subtypes Across the Life Course.
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DOI：
10.1161/jaha.121.021751
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发表时间：
2021-12-07
影响因子：
5.4
通讯作者：
Sweis, Ranya
中科院分区：
文献类型：
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作者：
Khan, Sadiya S.;Ning, Hongyan;Sinha, Arjun;Wilkins, John;Allen, Norrina B.;Vu, Thanh Huyen T.;Berry, Jarett D.;Lloyd-Jones, Donald M.;Sweis, Ranya
吸烟与过早死亡显著相关，而与心血管疾病无关。与吸烟相关的风险是否在不同的心血管疾病亚型中相似，以及这如何转化为寿命损失年数尚不清楚。我们汇集和协调了来自美国9个基于人口的队列的个人水平的数据。所有参与者在基线时都没有临床心血管疾病，并有关于当前吸烟状况、协变量和心血管疾病结局的可用数据。我们研究了吸烟状况与总心血管疾病和心血管疾病亚型之间的关系，包括致命性和非致命性冠心病、中风、充血性心力衰竭和其他心血管死亡。我们进行了(1)修正的Kaplan-Meier分析来估计长期风险，(2)调整了竞争的Cox模型来估计心血管疾病或非心血管死亡的联合累积风险，以及(3)Irwin的限制性平均数来估计无心血管疾病和有心血管疾病的生存年限。在106-165名成年人中，50.4%是女性。中年男性和女性发生心血管事件的总体长期风险分别为46.0%(95%可信区间，44.7-47.3)和34.7%(95%可信区间，33.3-36.0)。在报告吸烟的中年男性中，与不吸烟的人相比，首次出现致命心血管事件的竞争危险比(HR)更高(HR，1.79[95%CI，1.68-1.92])，女性中也有类似的模式(HR，1.82[95%CI，1.68-1.98])。在男性和女性中，吸烟与心血管疾病的发病早5.1年和3.8年有关。在年轻人和老年人中也观察到了类似的模式。作为临床脑血管病的首发症状，当前吸烟与致命事件有关。
Cigarette smoking is significantly associated with premature death related and not related to cardiovascular disease (CVD). Whether risk associated with smoking is similar across CVD subtypes and how this translates into years of life lost is not known. We pooled and harmonized individual‐level data from 9 population‐based cohorts in the United States. All participants were free of clinical CVD at baseline with available data on current smoking status, covariates, and CVD outcomes. We examined the association between smoking status and total CVD and CVD subtypes, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. We performed (1) modified Kaplan–Meier analysis to estimate long‐term risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) Irwin’s restricted mean to estimate years lived free from and with CVD. Of 106 165 adults, 50.4% were women. Overall long‐term risks for CVD events were 46.0% (95% CI, 44.7–47.3) and 34.7% (95% CI, 33.3–36.0) in middle‐aged men and women, respectively. In middle‐aged men who reported smoking compared with those who did not smoke, competing hazard ratios (HRs) were higher for the first presentation being a fatal CVD event (HR, 1.79 [95% CI, 1.68–1.92]), with a similar pattern among women (HR,1.82 [95% CI, 1.68–1.98]). Smoking was associated with earlier CVD onset by 5.1 and 3.8 years in men and women. Similar patterns were observed in younger and older adults. Current smoking was associated with a fatal event as the first manifestation of clinical CVD.