无烟烟草使用者冠心病发病风险：全球系统性综述和荟萃分析
2018/03/19
摘要
背景：无烟烟草使用（SLT）过程中会出现多种副作用，包括口腔癌前病变和口腔癌。SLT与冠心病（CHD)相关的文献报道存有争议。本文旨在评价成人SLT应用与CHD发生风险，并进行亚组分析。方法：研究纳入所有评估CHD和SLT相关的文献。两位作者独立进行风险预测和人群特征数据分析。通过随机效应模型进行相对风险比的预测小结。
结果：来自4个WHO地区总计20项研究纳入分析。尽管致死性CHD风险较大(1.10, 95% CI 1.00-1.20)，但SLT患者CHD总体风险并无显著增高(1.05, 95% CI 0.96-1.15)。在欧洲地区风险显著增加(1.30, 95% CI 1.14-1.47)。根据吸烟情况进行严格调整后，结果仍未明显改变。产品来源分析提示鼻吸入式SLT应用致死性CHD风险显著提高(1.37, 95% CI 1.14-1.61)。归因于SLT致死性CHD比例为0.3%，欧洲地区比例最高(5%)。
结论：SLT应用和致死性CHD风险显著相关，尤其对于欧洲应用和鼻吸入应用者。考虑到经过吸烟因素调整后阳性结果依然存在，研究结果提示在现有致死性CHD控烟基础上，建议将SLT也纳入控烟范畴。
Risk of coronary heart disease among smokeless tobacco users: results of systematic review and meta-analysis of global data.
BACKGROUND:Use of smokeless tobacco (SLT) products has been linked to multiple adverse effects, especially precancer and cancer of oral cavity. However, the association of SLT use with risk of coronary heart disease (CHD) is shrouded with controversy due to conflicting results in the literature. The present meta-analysis aimed to evaluate the risk of CHD among adult ever-users of SLT products along with subgroup analysis.
METHODS:The analysis included studies retrieved from a systematic literature search for published articles assessing risk of CHD with SLT use. Two authors independently extracted risk estimates and study characteristics of the included studies. Summary relative risks were estimated using the random-effect model.
RESULTS:Twenty studies from four WHO regions were included in the analysis. The summary risk of CHD in SLT users was not significantly positive (1.05, 95% CI 0.96-1.15) although a higher risk of fatal CHD was seen (1.10, 95% CI 1.00-1.20). The risk was significant for users in European Region (1.30, 95% CI 1.14-1.47). The results remained unchanged even after strict adjustment for smoking. Product-wise analysis revealed a significant positive association of fatal CHD with snus/ snuff use (1.37, 95% CI 1.14-1.61). The SLT-attributable fraction of fatal CHD was calculated to be 0.3%, highest being for European region (5%).
CONCLUSION:A significant positive association was detected between SLT use and risk of fatal CHD, especially for European users and those consuming snus/ snuff. In view of the positive association even after strict adjustment for smoking, these results underscore the need for inclusion of cessation efforts for smokeless tobacco in addition to smoking for control of fatal cardiovascular diseases.
背景：无烟烟草使用（SLT）过程中会出现多种副作用，包括口腔癌前病变和口腔癌。SLT与冠心病（CHD)相关的文献报道存有争议。本文旨在评价成人SLT应用与CHD发生风险，并进行亚组分析。方法：研究纳入所有评估CHD和SLT相关的文献。两位作者独立进行风险预测和人群特征数据分析。通过随机效应模型进行相对风险比的预测小结。
结果：来自4个WHO地区总计20项研究纳入分析。尽管致死性CHD风险较大(1.10, 95% CI 1.00-1.20)，但SLT患者CHD总体风险并无显著增高(1.05, 95% CI 0.96-1.15)。在欧洲地区风险显著增加(1.30, 95% CI 1.14-1.47)。根据吸烟情况进行严格调整后，结果仍未明显改变。产品来源分析提示鼻吸入式SLT应用致死性CHD风险显著提高(1.37, 95% CI 1.14-1.61)。归因于SLT致死性CHD比例为0.3%，欧洲地区比例最高(5%)。
结论：SLT应用和致死性CHD风险显著相关，尤其对于欧洲应用和鼻吸入应用者。考虑到经过吸烟因素调整后阳性结果依然存在，研究结果提示在现有致死性CHD控烟基础上，建议将SLT也纳入控烟范畴。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Nicotine Tob Res. 2018 Jan 9. ）
（Nicotine Tob Res. 2018 Jan 9. ）
Risk of coronary heart disease among smokeless tobacco users: results of systematic review and meta-analysis of global data.
Gupta R et al.
AbstractBACKGROUND:Use of smokeless tobacco (SLT) products has been linked to multiple adverse effects, especially precancer and cancer of oral cavity. However, the association of SLT use with risk of coronary heart disease (CHD) is shrouded with controversy due to conflicting results in the literature. The present meta-analysis aimed to evaluate the risk of CHD among adult ever-users of SLT products along with subgroup analysis.
METHODS:The analysis included studies retrieved from a systematic literature search for published articles assessing risk of CHD with SLT use. Two authors independently extracted risk estimates and study characteristics of the included studies. Summary relative risks were estimated using the random-effect model.
RESULTS:Twenty studies from four WHO regions were included in the analysis. The summary risk of CHD in SLT users was not significantly positive (1.05, 95% CI 0.96-1.15) although a higher risk of fatal CHD was seen (1.10, 95% CI 1.00-1.20). The risk was significant for users in European Region (1.30, 95% CI 1.14-1.47). The results remained unchanged even after strict adjustment for smoking. Product-wise analysis revealed a significant positive association of fatal CHD with snus/ snuff use (1.37, 95% CI 1.14-1.61). The SLT-attributable fraction of fatal CHD was calculated to be 0.3%, highest being for European region (5%).
CONCLUSION:A significant positive association was detected between SLT use and risk of fatal CHD, especially for European users and those consuming snus/ snuff. In view of the positive association even after strict adjustment for smoking, these results underscore the need for inclusion of cessation efforts for smokeless tobacco in addition to smoking for control of fatal cardiovascular diseases.
