Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.
Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.
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DOI：
10.1093/ije/dyu218
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发表时间：
2015-02
影响因子：
7.7
通讯作者：
Hemingway H
中科院分区：
文献类型：
--
作者：
Pujades-Rodriguez M;George J;Shah AD;Rapsomaniki E;Denaxas S;West R;Smeeth L;Timmis A;Hemingway H
背景目前尚不清楚吸烟如何影响各种慢性和急性心血管疾病(CVD)的初始表现，也不知道这种联系的异质性程度。我们估计了12例心血管疾病患者的终生累积发病率，并研究了吸烟和戒烟之间的关系。方法对1997年至2010年间年龄30岁、无脑血管病病史的193万名≥患者进行队列研究。个人从英格兰链接的电子健康记录中提取，包括初级保健、住院治疗、心肌梗死(MI)登记和特定原因死亡(CALIBER计划)。结果在1160万人年的随访中，114859名 患者出现了最初的非致命性或致命性心血管疾病。到90岁时，现在吸烟者和从不吸烟者的终生风险从蛛网膜下腔出血(SAH)的0.4%和0.2%到外周动脉疾病(PAD)的8.9%和2.6%不等。目前吸烟与心脏骤停或心源性猝死无关[危险比(HR) = 1.04，95%可信区间(CI)0.91-1.19]。不同疾病类型的关联强度明显不同：稳定型心绞痛(HR = 1.08，95%CI 1.01-1.15)，短暂性脑缺血发作(HR = 1.41，95%CI 1.28-1.55)，不稳定型心绞痛(HR = 1.54，95%CI 1.38-1.72)，脑出血(HR = 1.61，95%CI 1.37-1.89)，心力衰竭(HR = 1.62，95%CI 1.47-1.79)，缺血性中风(HR = 1.90，95%CI 1.72-2.10)，MI(HR = 2.32，95%CI 2.20-2.45)，SAH(HR = 2.70，95%CI 2.27-3.21)，PAD(HR = 5.16，95%CI为4.80~5.54)和腹主动脉瘤(HR = 为5.18，95%CI为4.61~5.82)。女性在无征兆冠状动脉死亡、缺血性中风、PAD和AAA方面的人群归因分数低于男性。戒烟10年后，男性患PAD、腹主动脉瘤和非预告性冠状动脉死亡的风险仍然增加(HR = 分别为1.36、1.47和2.74)。结论吸烟与不同的CVD表现存在不同的相关性，提示不同的潜在机制，对研究、临床筛查和风险预测具有重要意义。
Background It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation. Methods Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997–2010. Individuals were drawn from linked electronic health records in England, covering primary care, hospitalizations, myocardial infarction (MI) registry and cause-specific mortality (the CALIBER programme). Results During 11.6 million person-years of follow-up, 114 859 people had an initial non-fatal or fatal CVD presentation. By age 90 years, current vs never smokers’ lifetime risks varied from 0.4% vs 0.2% for subarachnoid haemorrhage (SAH), to 8.9% vs 2.6% for peripheral arterial disease (PAD). Current smoking showed no association with cardiac arrest or sudden cardiac death [hazard ratio (HR) = 1.04, 95% confidence interval (CI) 0.91–1.19).The strength of association differed markedly according to disease type: stable angina (HR = 1.08, 95% CI 1.01–1.15),transient ischaemic attack (HR = 1.41, 95% CI 1.28-1.55), unstable angina (HR = 1.54, 95% CI 1.38–1.72), intracerebral haemorrhage (HR = 1.61, 95% CI 1.37–1.89), heart failure (HR = 1.62, 95% CI 1.47–1.79), ischaemic stroke (HR = 1.90, 95% CI 1.72–2.10), MI (HR = 2.32, 95% CI 2.20–2.45), SAH (HR = 2.70, 95% CI 2.27–3.21), PAD (HR = 5.16, 95% CI 4.80–5.54) and abdominal aortic aneurysm (AAA) (HR = 5.18, 95% CI 4.61–5.82). Population-attributable fractions were lower for women than men for unheralded coronary death, ischaemic stroke, PAD and AAA. Ten years after quitting smoking, the risks of PAD, AAA (in men) and unheralded coronary death remained increased (HR = 1.36, 1.47 and 2.74, respectively). Conclusions The heterogeneous associations of smoking with different CVD presentations suggests different underlying mechanisms and have important implications for research, clinical screening and risk prediction.
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影响因子：
4.8
作者：
Gopal, Deepa M.;Kalogeropoulos, Andreas P.;Butler, Javed
通讯作者：
Butler, Javed
DOI：
10.1056/nejmoa1012848
发表时间：
2012-01-26
期刊：
The New England journal of medicine
影响因子：
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作者：
Berry JD;Dyer A;Cai X;Garside DB;Ning H;Thomas A;Greenland P;Van Horn L;Tracy RP;Lloyd-Jones DM
通讯作者：
Lloyd-Jones DM
影响因子：
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作者：
Domingo Sagastagoitia, Jose;Saez, Yolanda;Antonio Iriarte, Jose
通讯作者：
Antonio Iriarte, Jose
DOI：
10.1136/bmj.f2350
发表时间：
2013-05-20
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Herrett E;Shah AD;Boggon R;Denaxas S;Smeeth L;van Staa T;Timmis A;Hemingway H
通讯作者：
Hemingway H
影响因子：
5.7
作者：
Mackay, D. F.;Irfan, M. O.;Pell, J. P.
通讯作者：
Pell, J. P.