戒烟后体重增加未降低戒烟对心肌梗死和脑卒中的保护作用
2018/03/19
目的：本研究旨在评估戒烟和戒烟后BMI和心肌梗死（MI）和脑卒中的发生风险。
材料与方法：前瞻性队列研究利用NHIS数据库收集2002年至2013年相关数据，分为第一个检查段（2002-03）和第二个检查段（2004-05），108242名年龄大于40岁既往无MI或脑卒中诊断患者被分为持续吸烟者、BMI增长戒烟者、BMI未增长戒烟者和BMI下降戒烟者。BMI变化定义为在两个检查时间段之间大小超过1.0kg/m2。受试者自2006年1月起随访至2013年12月。风险比（HRs）和95%CI通过Cox比例风险模型计算，并根据社会人口、个人健康状态、家庭健康情况进行调整。与持续吸烟者相比，戒烟伴BMI增加者（MI: HR 0.33; 95% CI 0.16-0.70 ; 脑卒中：HR 0.75; 95% CI 0.57-1.00）和戒烟伴BMI未变化者(MI: HR 0.55; 95% CI 0.37-0.83; 脑卒中：HR 0.75; 95% CI 0.62-0.92)，但在戒烟伴BMI降低者中无明显差异（MI: HR 0.91; 95% CI 0.43-1.91脑卒中：HR 0.86; 95% CI 0.57-1.31）。相较于持续吸烟者，非吸烟者MI(HR 0.37; 95% CI 0.32-0.43)和脑卒中风险显著下降(HR 0.68; 95% CI 0.64-0.73)。
结论：戒烟后BMI变化并未改变戒烟降低MI和脑卒中风险的获益。
（Eur Heart J. 2018 Jan 6. ）
Weight gain after smoking cessation does not modify its protective effect on myocardial infarction and stroke: evidence from a cohort study of men.
Kim K, Park SM, Lee K.
Abstract
AIMS:This study aimed to investigate the association between smoking cessation, post-cessation body mass index (BMI) change and risk of myocardial infarction (MI) and stroke in men.
METHODS AND RESULTS:A prospective cohort study using the National Health Insurance Service (NHIS) data set collected from 2002 to 2013 was implemented. Based on the first (2002-03) and second (2004-05) NHIS health check-up periods, 108 242 men aged over 40 years without previous diagnoses of MI or stroke were grouped into sustained smokers, quitters with BMI gain, quitters without BMI change, quitters with BMI loss, and non-smokers. Body mass index change was defined as the difference of more than 1.0 kg/m2 between the two health check-up periods. The participants were followed-up from 1 January 2006 to 31 December 2013. Hazard ratios (HRs) and 95% confidence intervals (HR, 95% CI) were computed using Cox proportional hazard models adjusted for sociodemographic, health status, and family health history. Compared to the sustained smokers, the risk of MI and stroke was significantly reduced in both quitters with BMI gain (HR 0.33; 95% CI 0.16-0.70 for MI and HR 0.75; 95% CI 0.57-1.00 for stroke) and without BMI change (HR 0.55; 95% CI 0.37-0.83 for MI and HR 0.75; 95% CI 0.62-0.92 for stroke), but no significant association was found in quitters with BMI loss (HR 0.91; 95% CI 0.43-1.91 for MI and HR 0.86; 95% CI 0.57-1.31 for stroke), respectively. Non-smokers had lower risk of MI (HR 0.37; 95% CI 0.32-0.43) and stroke (HR 0.68; 95% CI 0.64-0.73) compared to the sustained smokers.
CONCLUSION:Post-cessation BMI change did not significantly modify the protective association of smoking cessation with MI and stroke.
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