高血压患者不良生活习惯与心血管疾病死亡和全因死亡风险关系的研究

Relationship between bad habits and the death of cardiovascular disease and all-cause death risk in patients with essential hypertension

目的探讨吸烟对饮酒高血压患者心血管疾病死亡(CVDM)和全因死亡(ACM)风险的影响,分析吸烟量和饮酒量同时升高对饮酒高血压患者死亡和全因死亡风险是否存在协同作用。方法选取2004年1~12月我院老年病科诊治的饮酒高血压患者1 000例。收集所有患者的人口统计学信息、吸烟信息及个人疾病史等资料,随访记录患者的CVDM和ACM。采用COX比例风险模型分析吸烟指标对饮酒高血压患者CVDM和ACM风险的影响。结果在CVDM风险和ACM发生风险方面:每日吸烟量>10支高于1~10支,累计吸烟量≥20包/年高于0.1~19包/年,吸烟年限>35年高于1~35年,开始吸烟年龄<20岁高于>20岁,差异均具有统计学意义(P<0.05);当每日饮酒量>200 ml/d,累计饮酒量≥20(盅/年),饮酒年限>35年或饮酒开始年龄≤20岁患者的CVDM风险分别为RR=2.352、2.693、2.254、2.336;ACM风险分别为RR=3.092、2.346、1.936、2.018。结论吸烟可增加饮酒高血压患者CVDM和ACM风险,风险的大小与吸烟量和吸烟年限呈剂量反应关系;饮酒量和吸烟量同时升高可进一步增加此风险。

Objective To investigate the effect of smoking on cardiovascular disease mortality(CVDM) and the risk of all-cause death(ACM) in patients with essential hypertension who have drinking habits, and to analyze the synergistic effect of smoking quantity and alcohol consumption on the risk of CVDM and ACM. Methods The clinical data of 1 000 patients with hypertension who were treated in the Department of Geriatrics in our hospital from January2004 to December 2004 were collected, including demographic information, smoking information, and individual disease history. CVDM and ACM were recorded during the follow-up. COX proportional hazard model was used to analyze the effect of smoking on the risk of ACM and CVDM in patients. Results The risk of CVDM and ACM was higher in patients with daily smoking of more than cigarettes than the patients with daily smoking of 1~10 cigarettes, and in patients with cumulative smoking amount of more than 20 pack in one year than the patients with cumulative smoking amount of 0.1~19 pack in one year, and also in the patients with smoking history of >35 years than the patients with smoking history of 1~35 years, as well as in the patients with the starting-smoking-age of <20 years old than the patients with the starting-smoking-age of >20 years old, The differences were all statistically significant(P<0.05). For patients with daily alcohol consumption of >200 ml/d, cumulative alcohol consumption of more than 20 cups in one year, drinking history of >35 years, sarting-drinking-age of ≤20 years old, the risks of CVDM(RR) were 2.352, 2.693, 2.254, 2.336, and the risks of ACM were 3.092, 2.346, 1.936, 2.018, respectively. Conclusion Smoking can increase the risk of ACM and CVDM in patients with essential hypertension who have drinking habits, and the risk showed a dose-response relationship with smoking quantity and smoking years. Increase of alcohol and smoking consumption can further increase the risk.