吸烟和戒烟对脂质和脂蛋白的影响：来自随机临床试验的结果
2011/03/28
摘要
背景：尚未在同一时期进行大规模的试验，研究吸烟和戒烟对脂蛋白的影响。本试验旨在研究戒烟对脂蛋白的影响。
方法：本试验是一项为期1年的前瞻性、双盲、随机、安慰剂-对照临床研究，研究5种戒烟药物治疗的疗效。在戒烟前和戒烟后1年，采用核磁共振波谱法检测空腹状态下的脂蛋白谱。采用多变量回归分析戒烟对脂蛋白的影响和戒烟后1年脂蛋白变化的预测因素。
结果：1504名当前吸烟者入选，平均年龄为45.4 (11.3)岁，基线状态下每天吸烟21.4 (8.9)支。923名成人吸烟者在1年后返回进行随访，334名(36.2%)存在持续戒烟。与继续吸烟者相比，尽管戒烟者出现体重增加(4.6 kg [5.7] vs 0.7 kg [5.1], P <0.001]，但高密度脂蛋白胆固醇(HDL-C)增加(2.4 [8.3] vs 0.1 [8.8] mg/dL, P <0.001)、总HDL增加、(1.0 [4.6] vs -0.3 µmol/L [5.0], P <0.001)、大HDL颗粒增加(0.6 [2.2] vs 0.1 [2.1] µmol/L, P =0.003)。低密度脂蛋白(LDL)胆固醇和LDL颗粒未见显著变化。校正后，戒烟分别与HDL-C和总HDL颗粒相关(P <0.001)。这些相关性在女性更为明显。
结论：尽管存在体重增加，戒烟能改善HDL-C、总HDL和大HDL颗粒，特别是对女性吸烟者。戒烟对LDL 和LDL无影响。HDL增加了戒烟后心血管疾病风险下降。
（林江涛 审校）
Am Heart J. 2011 Jan;161(1):145-151.
Effects of smoking and smoking cessation on lipids and lipoproteins: Outcomes from a randomized clinical trial.
Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH.
Abstract
BACKGROUND: The effects of smoking and smoking cessation on lipoproteins have not been studied in a large contemporary group of smokers. This study was designed to determine the effects of smoking cessation on lipoproteins.
METHODS: This was a 1-year, prospective, double-blind, randomized, placebo-controlled clinical trial of the effects of 5 smoking cessation pharmacotherapies. Fasting nuclear magnetic resonance spectroscopy lipoprotein profiles were obtained before and 1 year after the target smoking cessation date. The effects of smoking cessation and predictors of changes in lipoproteins after 1 year were identified by multivariable regression.
RESULTS: The 1,504 current smokers were (mean [SD]) 45.4 (11.3) years old and smoked 21.4 (8.9) cigarettes per day at baseline. Of the 923 adult smokers who returned at 1 year, 334 (36.2%) had quit smoking. Despite gaining more weight (4.6 kg [5.7] vs 0.7 kg [5.1], P < .001], abstainers had increases in high-density lipoprotein cholesterol (HDL-C) (2.4 [8.3] vs 0.1 [8.8] mg/dL, P < .001), total HDL (1.0 [4.6] vs -0.3 µmol/L [5.0], P < .001), and large HDL (0.6 [2.2] vs 0.1 [2.1] µmol/L, P = .003) particles compared with continuing smokers. Significant changes in low-density lipoprotein (LDL) cholesterol and particles were not observed. After adjustment, abstinence from smoking (P < .001) was independently associated with increases in HDL-C and total HDL particles. These effects were stronger in women.
CONCLUSIONS: Despite weight gain, smoking cessation improved HDL-C, total HDL, and large HDL particles, especially in women. Smoking cessation did not affect LDL or LDL size. Increases in HDL may mediate part of the reduced cardiovascular disease risk observed after smoking cessation.
Am Heart J. 2011 Jan;161(1):145-51.
背景：尚未在同一时期进行大规模的试验，研究吸烟和戒烟对脂蛋白的影响。本试验旨在研究戒烟对脂蛋白的影响。
方法：本试验是一项为期1年的前瞻性、双盲、随机、安慰剂-对照临床研究，研究5种戒烟药物治疗的疗效。在戒烟前和戒烟后1年，采用核磁共振波谱法检测空腹状态下的脂蛋白谱。采用多变量回归分析戒烟对脂蛋白的影响和戒烟后1年脂蛋白变化的预测因素。
结果：1504名当前吸烟者入选，平均年龄为45.4 (11.3)岁，基线状态下每天吸烟21.4 (8.9)支。923名成人吸烟者在1年后返回进行随访，334名(36.2%)存在持续戒烟。与继续吸烟者相比，尽管戒烟者出现体重增加(4.6 kg [5.7] vs 0.7 kg [5.1], P <0.001]，但高密度脂蛋白胆固醇(HDL-C)增加(2.4 [8.3] vs 0.1 [8.8] mg/dL, P <0.001)、总HDL增加、(1.0 [4.6] vs -0.3 µmol/L [5.0], P <0.001)、大HDL颗粒增加(0.6 [2.2] vs 0.1 [2.1] µmol/L, P =0.003)。低密度脂蛋白(LDL)胆固醇和LDL颗粒未见显著变化。校正后，戒烟分别与HDL-C和总HDL颗粒相关(P <0.001)。这些相关性在女性更为明显。
结论：尽管存在体重增加，戒烟能改善HDL-C、总HDL和大HDL颗粒，特别是对女性吸烟者。戒烟对LDL 和LDL无影响。HDL增加了戒烟后心血管疾病风险下降。
（林江涛 审校）
Am Heart J. 2011 Jan;161(1):145-151.
Effects of smoking and smoking cessation on lipids and lipoproteins: Outcomes from a randomized clinical trial.
Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH.
Abstract
BACKGROUND: The effects of smoking and smoking cessation on lipoproteins have not been studied in a large contemporary group of smokers. This study was designed to determine the effects of smoking cessation on lipoproteins.
METHODS: This was a 1-year, prospective, double-blind, randomized, placebo-controlled clinical trial of the effects of 5 smoking cessation pharmacotherapies. Fasting nuclear magnetic resonance spectroscopy lipoprotein profiles were obtained before and 1 year after the target smoking cessation date. The effects of smoking cessation and predictors of changes in lipoproteins after 1 year were identified by multivariable regression.
RESULTS: The 1,504 current smokers were (mean [SD]) 45.4 (11.3) years old and smoked 21.4 (8.9) cigarettes per day at baseline. Of the 923 adult smokers who returned at 1 year, 334 (36.2%) had quit smoking. Despite gaining more weight (4.6 kg [5.7] vs 0.7 kg [5.1], P < .001], abstainers had increases in high-density lipoprotein cholesterol (HDL-C) (2.4 [8.3] vs 0.1 [8.8] mg/dL, P < .001), total HDL (1.0 [4.6] vs -0.3 µmol/L [5.0], P < .001), and large HDL (0.6 [2.2] vs 0.1 [2.1] µmol/L, P = .003) particles compared with continuing smokers. Significant changes in low-density lipoprotein (LDL) cholesterol and particles were not observed. After adjustment, abstinence from smoking (P < .001) was independently associated with increases in HDL-C and total HDL particles. These effects were stronger in women.
CONCLUSIONS: Despite weight gain, smoking cessation improved HDL-C, total HDL, and large HDL particles, especially in women. Smoking cessation did not affect LDL or LDL size. Increases in HDL may mediate part of the reduced cardiovascular disease risk observed after smoking cessation.
Am Heart J. 2011 Jan;161(1):145-51.
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1型大麻素受体拮抗剂在戒烟中的作用
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