中国10个地区成年人心力衰竭流行情况及其吸烟影响因素研究

Prevalence of heart failure and its association with smoking behavior in adults from 10 regions of China

目的:描述我国心力衰竭(心衰)流行情况,探究吸烟行为与心衰发病风险的前瞻性关联。方法:研究对象来自中国慢性病前瞻性研究,基线调查为2004年6月至2008年7月。剔除BMI信息缺失、基线调查后即失访以及基线自报有冠心病、脑卒中或恶性肿瘤的研究对象,共纳入487197人进行分析。本研究使用的随访数据截至2016年12月31日。采用Cox比例风险模型计算吸烟行为与心衰发病风险的关联。结果:研究对象中位随访10.15年,随访期间共有4208人新发心衰,粗发病率为0.87/1000人年,累积发病率为0.86%。基线年龄越大,心衰发病率越高。高年龄组、农村、男性心衰发病率分别高于低年龄组、城市、女性人群。相比于非吸烟者,偶尔吸烟者心衰发病风险无显著差异(HR=1.05;95%CI:0.91~1.22),而既往吸烟者(HR=1.48;95%CI:1.31~1.67)和当前吸烟者(HR=1.34;95%CI:1.22~1.49)的风险升高。合并非吸烟或偶尔吸烟者组后,既往吸烟者(HR=1.33;95%CI:1.21~1.46)和当前吸烟者(HR=1.46;95%CI:1.31~1.64)相比于该组的心衰发病风险均升高。当前吸烟者(趋势检验P=0.347)和既往吸烟者(趋势检验P=0.066)的吸烟量与心衰风险间均不存在剂量反应关系。与非吸烟或偶尔吸烟组相比,既往吸烟者戒烟<5、5~、10~、≥20年的心衰发病风险比分别为1.61(95%CI:1.36~1.92)、1.55(95%CI:1.27~1.90)、1.24(95%CI:1.02~1.51)、1.35(95%CI:1.08~1.68)(趋势检验P=0.091),非因疾病戒烟者与因疾病戒烟者心衰发病风险比分别为1.23(95%CI:1.04~1.45)和1.62(95%CI:1.41~1.86)。健康吸烟行为较非健康吸烟行为对心力衰竭有明显的保护作用(HR=0.75;95%CI:0.69~0.81)。城乡地区和冠心病家族史与吸烟行为是否健康存在对心衰发病风险的交互作用(交互检验P<0.05)。结论:我国心力衰竭发病率男性高于女性,农村高于城市,随年龄增长而升高。无论吸烟频率、吸烟量、戒烟时长和戒烟原因,既往吸烟和当前吸烟者相比于从不吸烟或偶尔吸烟者,心衰风险均较高。吸烟是心力衰竭的重要危险因素,应继续坚持全面禁烟措施。

Objective To describe the prevalence of heart failure in China and to explore the prospective association between smoking behavior and the risk of incident heart failure.Methods The subjects were from the China Kadoorie Biobank(CKB)and the baseline survey was conducted from June 2004 to July 2008.A total of 487197 subjects were included in this study,after excluding those with missing BMI information,lost follow-up immediately after baseline investigation,and self-reported coronary heart disease,stroke,or malignant tumor at baseline.This study included data from baseline and follow-up until December 31,2016.Cox proportional hazards regression models were used to estimate the association between smoking behavior and the risk of heart failure.Results The median follow-up time was 10.15 years,during which a total of 4208 new cases of heart failure occurred,with a crude incidence rate of 0.87/1000 person-years and a cumulative incidence rate of 0.86%.The higher the age at baseline,the higher the incidence of heart failure.The incidence of heart failure in high age group,rural area and male was higher than that in low age group,urban area and female population respectively.Compared with non-smokers,there was no significant difference in the risk of heart failure in occasional smokers(HR=1.05;95%CI:0.91-1.22),while former smokers(HR=1.48;95%CI:1.31-1.67)and current smokers(HR=1.34;95%CI:1.22-1.49)increased risk.Former smokers(HR=1.33;95%CI:1.21-1.46)and current smokers(HR=1.46;95%CI:1.31-1.64)had higher risk of heart failure than non-smokers or occasional smokers.No dose-response relationship was observed between the number of cigarettes smoked per day and the risk of heart failure in current and former smokers(for trend P=0.347 and 0.066).Compared with non-smokers or occasional smokers,the hazard ratios of<5,5-,10-and≥20 years since quit smoking were 1.61(95%CI:1.36-1.92),1.55(95%CI:1.27-1.90),1.24(95%CI:1.02-1.51)and 1.35(95%CI:1.08-1.68),respectively(for trend P=0.091).The hazard ratios of quitting smoking due to disease and other reasons were 1.62(95%CI:1.41-1.86)and 1.23(95%CI:1.04-1.45).Healthy smoking behaviors had a significant protective effect on heart failure compared with non-healthy smoking behaviors(HR=0.75,95%CI:0.69-0.81).Area and family history of coronary heart disease,and the smoking behaviors interacted with the risk of heart failure(for all interactions were P<0.05).Conclusions The incidence of heart failure in China is higher in males than females,higher in rural areas than in urban areas,and increases with age.Both former smokers and current smokers had a higher risk of heart failure than nonsmokers or occasional smokers,regardless of the frequency,amount,duration,and reason for quitting.Smoking is an important risk factor for heart failure and comprehensive anti-smoking measures should be maintained.