临床研究
ENGLISH ABSTRACT
吸烟与中青年女性急性冠状动脉综合征患者冠状动脉病变程度的关联研究
胡国良
刘静
刘军
郝永臣
杨娜
周梦戈
曾雨虹
赵冬
代表中国心血管疾病医疗质量改善项目全体研究者
作者及单位信息
·
DOI: 10.3760/cma.j.cn112148-20191115-00702
Association between smoking and the severity of coronary lesions among young and middle-aged female patients with acute coronary syndrome
Hu Guoliang
Liu Jing
Liu Jun
Hao Yongchen
Yang Na
Zhou Mengge
Zeng Yuhong
Zhao Dong
on behalf of all Investigators in the Improving Care for Cardiovascular Disease in China Project
Authors Info & Affiliations
Hu Guoliang
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Liu Jing
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Liu Jun
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Hao Yongchen
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Yang Na
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Zhou Mengge
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Zeng Yuhong
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Zhao Dong
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
on behalf of all Investigators in the Improving Care for Cardiovascular Disease in China Project
·
DOI: 10.3760/cma.j.cn112148-20191115-00702
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摘要

目的探讨吸烟对中青年女性急性冠状动脉综合征(ACS)患者冠状动脉病变严重程度的影响。

方法本研究基于中华医学会心血管病学分会和美国心脏协会合作开展的"中国心血管疾病医疗质量改善项目"。该项目自2014年起,在中国158家三级医院和82家二级医院连续入选ACS住院患者,系统地收集患者的临床相关信息和评价医疗质量。本研究纳入标准包括:年龄<60岁、首次发生ACS的女性患者且住院期间接受过冠状动脉造影。根据其吸烟状态将研究人群分为吸烟者和不吸烟者,采用多因素logistic回归分析吸烟与中青年女性ACS患者冠状动脉病变严重程度的关系。

结果本研究纳入2 863例符合入选标准的中青年女性ACS患者,其中340例(12%)为吸烟者。与不吸烟患者(2 523例)比较,吸烟患者45岁以下发病占比更高[13.2%(45/340)比8.5%(215/2 523), P<0.01],合并高血压[59.4%(202/340)比66.7%(1 683/2 523), P<0.01]和糖尿病[39.4%(134/340)比44.2%(1 116/2 523), P=0.09]比例较低,但ST段抬高型心肌梗死的比例更高[66.8%(227/340)比53.7%(1 354/2 523), P<0.01],具有冠状动脉多支血管病变[39.1%(133/340)比32.6%(822/2 523), P<0.01]、冠状动脉单支血管重度狭窄[56.2%(109/194)比46.1%(706/1 530), P<0.01]和多支血管重度狭窄[63.2%(84/133)比58.2%(478/822), P=0.29]的比例均高于不吸烟者。在调整了年龄、高血压、糖尿病、高低密度脂蛋白胆固醇、低高密度脂蛋白胆固醇、高甘油三酯、肾功能不全、冠心病家族史和ACS类型后,与不吸烟的中青年女性患者相比,吸烟中青年女性患者的冠状动脉多支血管病变、冠状动脉多支血管严重病变和冠状动脉严重病变的比值比(95 %CI)分别是1.41(1.11~1.79)、1.40(1.10~1.78)和1.78(1.11~2.87)。

结论吸烟与中青年女性ACS患者冠状动脉广泛病变及严重病变的风险增加有明确关联,为进一步认识吸烟行为的危害、加强中青年女性的控烟教育和戒烟指导提供了重要依据。

冠状动脉疾病;吸烟;中青年;女性
ABSTRACT

ObjectiveTo investigate the association between smoking and the severity of coronary lesions among young and middle-aged female patients with acute coronary syndrome (ACS).

MethodsData of this study were derived from the Improving Care for Cardiovascular Disease in China (CCC)-ACS project, a collaborative study of the Chinese Society of Cardiology and the American Heart Association. Since 2014, the CCC-ACS project consecutively enrolled inpatients with ACS, systematically collected their clinical data and evaluated medical quality of these patients from 158 tertiary hospitals and 82 secondary hospitals across China. This study enrolled female patients less than 60 years old with initial ACS, who received coronary angiography in CCC-ACS project. Patients were divided into two groups according to smoking status. A multivariate logistic regression analysis was used to analyze the association between smoking and the severity of coronary lesions among young and middle-aged female patients with ACS.

ResultsA total of 2 863 female patients younger than 60 years old with initial ACS, who received coronary angiography, were enrolled. Among them, 12% (340 cases) was smokers. Proportion of patients younger than 45 years old was higher (13.2% (45/340) vs. 8.5% (215/2 523), P<0.01) and prevalence of hypertension (59.4% (202/340) vs. 66.7% (1 683/2 523), P<0.01) and diabetes (39.4% (134/340) vs. 44.2% (1 116/2 523), P=0.09) was lower in smoker group than in non-smoker group. However, prevalence of ST-elevation myocardial infarction (66.8% (227/340) vs. 53.7% (1 354/2 523), P<0.01), coronary multi-vessel lesions (39.1% (133/340) vs. 32.6% (822/2 523), P<0.01) and severe stenosis in either single-vessel (56.2% (109/194) vs. 46.1% (706/1 530), P<0.01) or multi-vessel (63.2% (84/133) vs. 58.2% (478/822), P=0.29) was significantly higher in smoker group than in non-smoker group. Multivariate logistic regression analyses showed that after adjusting for age, hypertension, diabetes, elevated low-density lipoprotein cholesterol, lower high-density lipoprotein cholesterol, elevated triglyceride, renal insufficiency, family history of coronary heart disease and types of ACS, smokers faced a higher risk of coronary multi-vessel lesions, coronary multi-vessel severe lesions and coronary severe lesions with the odds ratios and 95% confidence interval of 1.41 (1.11-1.79), 1.40 (1.10-1.78) and 1.78 (1.11-2.87), compared with non-smokers.

ConclusionsSmoking is significantly associated with an increased risk of extensive and severe coronary lesions among young and middle-aged female patients with ACS. This study provides crucial evidence for further understanding the harms of smoking and the need to strengthen the tobacco control education and smoking cessation guidance for young and middle-aged women.

Coronary artery disease;Smoking;Young and middle-aged;Female
Zhao Dong, Email: mocdef.aabnis.pivoahzeed
引用本文

胡国良,刘静,刘军,等. 吸烟与中青年女性急性冠状动脉综合征患者冠状动脉病变程度的关联研究[J]. 中华心血管病杂志,2020,48(05):378-385.

DOI:10.3760/cma.j.cn112148-20191115-00702

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冠心病是威胁我国居民生命健康的重要疾病和最主要的死因之一,其死亡率和发病率依然呈持续上升趋势 [ 1 ],特别是早发冠心病 [ 2 ]。大量证据显示吸烟是导致冠心病发生的重要的危险因素。但由于我国女性人群的吸烟率远远低于男性,所以我国关于吸烟问题的研究证据多来自于男性。但近年来的流行病学调查显示,我国年轻女性群体的吸烟率呈现持续上升趋势 [ 3 ]。因此,有必要进一步研究吸烟行为对我国中青年女性群体的危害。
冠状动脉造影是诊断冠心病的金标准,是评估冠状动脉粥样硬化病变严重程度的重要和更为直接的依据。既往关于吸烟与冠状动脉病变关系的研究多基于男性冠心病患者,对于我国女性吸烟对冠状动脉病变的危害评价极少,特别是吸烟与女性早发冠心病患者冠状动脉粥样硬化病变程度影响的研究证据更不充分。
本研究基于中华医学会心血管病学分会和美国心脏协会合作的"中国心血管疾病医疗质量改善(Improving Care for Cardiovascular Disease in China,CCC)项目",在全国30个省、直辖市和自治区共240家医院连续入选接受冠状动脉造影的首次发生急性冠状动脉综合征(acute coronary syndrome,ACS)的中青年女性住院患者,分析吸烟对中青年女性ACS患者冠状动脉病变严重程度的影响,旨在为我国中青年女性的控烟和戒烟教育及指导提供证据支持。
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备注信息
A
赵冬,Email: mocdef.aabnis.pivoahzeed
B
美国临床试验数据库(https://www.clinicaltrials.gov),NCT02306616
C
Clinicaltrials.gov (https://www.clinicaltrials.gov),NCT02306616
D
CCC项目是中华医学会心血管病学分会(CSC)和美国心脏协会(AHA)合作开展的项目,经费由辉瑞制药有限公司和阿斯利康制药有限公司资助
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