吸烟与高血压患者心血管疾病死亡和全因死亡关系的前瞻性队列研究

Relationship between Smoking and Cardiovascular Disease Mortality,All-cause Mortality in Hypertension Patients:A Prospective Cohort Study

目的探究吸烟与高血压患者心血管疾病死亡（CVDM）和全因死亡（ACM）的关系。方法选取2000年2月—2010年2月延安市中医医院收治的高血压患者6 457例,分析其人口学特征、吸烟及血压情况并进行随访,终点事件为CVDM和ACM,随访时间截止至2015年3月。采用Cox回归模型分析吸烟与高血压患者CVDM和ACM的关系。结果本组患者吸烟率为35.7%。患者平均随访8.7年,总随访56 175.9人年,随访期间出现ACM 1257例,其中655例为CDVM。Cox回归模型分析结果显示,吸烟患者的CVDM风险是不吸烟患者1.235倍〔RR=1.235,95%CI（1.070,1.490）〕,ACM风险是不吸烟患者的1.392倍〔RR=1.392,95%CI（1.040,1.853）〕;每日吸烟量1~10支和〉10支患者的CVDM风险分别是不吸烟患者的1.217倍〔RR=1.217,95%CI（1.075,1.523）〕、1.325倍〔RR=1.325,95%CI（1.123,1.768）〕,ACM风险分别是不吸烟患者的1.226倍〔RR=1.226,95%CI（1.117,1.648）〕、1.374倍〔RR=1.374,95%CI（1.172,1.829）〕;累计吸烟量2~399年支和≥400年支患者的CVDM风险分别是不吸烟患者的1.172倍〔RR=1.172,95%CI（1.045,1.556）〕、1.363倍〔RR=1.363,95%CI（1.158,1.758）〕,ACM风险分别是不吸烟患者的1.252〔RR=1.252,95%CI（1.162,1.648）〕、1.337倍〔RR=1.337,95%CI（1.266,1.794）〕;吸烟年限1~35年和〉35年患者的CVDM风险分别是不吸烟患者的1.194倍〔RR=1.194,95%CI（1.105,1.592）〕、1.341倍〔RR=1.341,95%CI（1.166,1.726）〕,ACM风险分别是不吸烟患者的1.324倍〔RR=1.324,95%CI（1.140,1.873）〕、1.405倍〔RR=1.405,95%CI（1.252,1.936）〕;开始吸烟年龄≤20岁和〉20岁患者的CVDM风险分别是不吸烟患者的1.373倍〔RR=1.373,95%CI（1.172,1.563）〕、1.205倍〔RR=1.205,95%CI（1.087,1.792）〕,ACM风险分别是不吸烟患者的1.414倍〔RR=1.414,95%CI（1.284,1.835）〕、1.221倍〔RR=1.221,95%CI（1.256,1.932）〕。累积吸烟量≥400年支且收缩压≥160 mm Hg的患者CVDM风险是不吸烟患者的2.352倍〔RR=2.352,95%CI（1.672,3.485）〕,ACM风险是不吸烟患者的3.092倍〔RR=3.092,95%CI（2.118,4.857）〕;累积吸烟量≥400年支且舒张压≥100 mm Hg的患者CVDM风险是不吸烟患者的2.633倍〔RR=2.633,95%CI（1.893,3.786）〕,ACM风险是不吸烟患者的2.346倍〔RR=2.346,95%CI（1.649,3.475）〕;累积吸烟量≥400年支且脉压≥70 mm Hg的患者CVDM风险是不吸烟患者的2.254倍〔RR=2.254,95%CI（1.573,3.452）〕,ACM风险是不吸烟患者的1.936倍〔RR=1.936,95%CI（1.207,2.995）〕;累积吸烟量≥400年支且高血压分级≥2级患者的CVDM风险是不吸烟患者的2.336倍〔RR=2.336,95%CI（1.674,3.502）〕,ACM风险是不吸烟患者的2.018倍〔RR=2.018,95%CI（1.152,2.764）〕。结论吸烟可增加高血压患者CVDM和ACM风险,且血压和吸烟量具有协同作用,可进一步增加CVDM和ACM风险。

Objective To investigate the relationship between smoking and cardiovascular disease mortality,all-cause mortality in hypertension patients. Methods A total of 6 457 patients with hypertension were selected in the Traditional Chinese Medicine Hospital of Yan＇an from February 2000 to February 2010,their demographic information,smoking status and blood pressure were collected,and they were followed up until March 2015, cardiovascular disease mortality and all- cause mortality served as endpoint events. Cox regression model was used to analyze the relationship between smoking and cardiovascular disease mortality,all- cause mortality in hypertension patients. Results The smoking rate of the 6 457 patients was 35. 7%. The average follow- up time was 8. 7 years,the total follow- up time was 56 175. 9 man- year. During follow-up,a total of 1 257 patients occurred all- cause mortality,thereinto 655 patients occurred cardiovascular disease mortality. Cox regression model analysis showed that, the occurrence risk of cardiovascular disease mortality of smoking patients was 1. 235 mulriples of non- smoking patients 〔RR = 1. 235,95% CI（ 1. 070,1. 490） 〕, that of all- cause mortality of was 1. 392 mulriples 〔RR = 1. 392,95% CI（ 1. 040,1. 853） 〕; the occurrence risk of cardiovascular disease mortality of smoking patients with daily smoking at 1 to 10 or over 10 was 1. 217,1. 325 mulriples of non- smoking patients 〔RR = 1. 217,95% CI（ 1. 075,1. 523）; RR = 1. 325,95% CI（ 1. 123,1. 768） 〕,respectively,that of all- cause mortality 10 was 1. 226,1. 374 mulriples〔RR = 1. 226,95% CI（ 1. 117,1. 648）; RR = 1. 374,95% CI（ 1. 172,1. 829） 〕,respectively; the occurrence risk of cardiovascular disease mortality of smoking patients with accumulative total smoking at 2 to 399 or equal or over 400 was 1. 172,1. 363 mulriples of non- smoking patients 〔RR = 1. 172, 95% CI（ 1. 045, 1. 556）; RR = 1. 363, 95% CI（ 1. 158,1. 758） 〕,respectively,that of all- cause mortality was 1. 252,1. 337 mulriples 〔RR = 1. 252,95% CI（ 1. 162,1. 648）;RR = 1. 337,95% CI（ 1. 266,1. 794） 〕, respectively; the occurrence risk of cardiovascular disease mortality of smoking patients with smoking time at 1 to 35 years or over 35 years was 1. 194,1. 341 mulriples of non- smoking patients 〔RR = 1. 194,95% CI（ 1. 105,1. 592）; RR = 1. 341,95% CI（ 1. 166,1. 726） 〕,respectively,that of all- cause mortality of was 1. 324,1. 405 mulriples 〔RR = 1. 324,95% CI（ 1. 140,1. 873）; RR = 1. 405,95% CI（ 1. 252,1. 936） 〕, respectively; the occurrence risk of cardiovascular disease mortality of smoking patients with smoking age below or equal 20 years old or over 20 years old was 1. 373,1. 205 mulriples of non- smoking patients 〔RR = 1. 373,95% CI（ 1. 172,1. 563）; RR = 1. 205,95%CI（ 1. 087, 1. 792） 〕, respectively, that of all- cause mortality was 1. 414, 1. 221 mulriples 〔RR = 1. 414, 95% CI（ 1. 284,1. 835）; RR = 1. 221,95% CI（ 1. 256,1. 932） 〕,respectively. The occurrence risk of cardiovascular disease mortality of smoking patients with accumulative total smoking equal or over 400 and SBP equal or over 160 mm Hg was 2. 352 mulriples of non- smoking patients 〔RR = 2. 352,95% CI（ 1. 672,3. 485） 〕,that of all- cause mortality was 3. 092 〔RR =3. 092,95% CI（ 2. 118, 4. 857） 〕; the occurrence risk of cardiovascular disease mortality of smoking patients with accumulative total smoking equal or over 400 and DBP equal or over 100 mm Hg was 2. 633 mulriples of non- smoking patients〔RR = 2. 633,95% CI（ 1. 893,3. 786） 〕,that of all- cause mortality was 2. 346 〔RR = 2. 346,95% CI（ 1. 649,3. 475） 〕; the occurrence risk of cardiovascular disease mortality of smoking patients with accumulative total smoking equal or over 400 and PP equal or over 70 mm Hg was 2. 254 mulriples of non- smoking patients 〔RR = 2. 254,95% CI（ 1. 573,3. 452） 〕, that of all- cause mortality was 1. 936 〔RR = 1. 936, 95% CI（ 1. 207, 2. 995） 〕; the occurrence risk of cardiovascular disease mortality of smoking patients with accumulative total smoking equal or over 400 and equal or over 2- grade hypertension was 2. 336 mulriples of non- smoking patients 〔RR = 2. 336,95% CI（ 1. 674,3. 502） 〕, that of all- cause mortality was 2. 018 〔RR = 2. 018,95% CI（ 1. 152,2. 764） 〕. Conclusion Smoking can increase the occurrence risk of cardiovascular disease mortality and all- cause mortality,and there is synergistic effect between smoking and blood pressure.