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1、吸烟与心血管疾病防控,南方医院 心内科 吴平生,内容,吸烟的形势 吸烟心血管疾病的独立危险因素 戒烟难慢性成瘾性疾病，且具有高复发性 医生的力量,中国烟草消耗量列全球之首,1997年世界烟草消耗量统计,中国不同人群吸烟率调查,男性,女性,调查人数及比率,%,%,公众,8178,66.0,7878,3.1,医生,2011,45.8,1634,1.3,GH Yang, ed. Smoking and passive smoking in Chinese 2002, Chin J epidemiol, 2005 Smoking behavior of doctors in 6 cities,Chin
2、a China Care study,心血管医生,29.8,1977,0.2,2031,调查人数及比率,内容,吸烟的形势 吸烟心血管疾病的独立危险因素 戒烟难慢性成瘾性疾病，且具有高复发性 医生的力量,心血管疾病的危险因素（中国NEHNS IV）,高血压 160M 血脂异常 160M 糖尿病 20MIFG 20M 肥胖 60M超重 200M 吸烟 350M 被动吸烟 540M,烟草和烟雾的主要成分研究,刺激物,慢性阻塞性呼吸道疾病,一氧化碳,心血管疾病,尼古丁,致成瘾，不致癌 2,1 Rockville, MD:Reducing the health consequences of smoki
3、ng: 25 years of progress. A report of the Surgeon General.US Department of Health and Human Services, 1989； 2 Waldum et al.:Long-term effect of inhaled nicotine. Life Sciences 1996;58:1339-1346,焦油,肿瘤,吸烟促发心血管疾病的发病机理,内皮功能紊乱 血栓生成增加 炎症反应加强 氧化修饰,Lavi et al. Circulation. 2007;115:2621-2627; http:/www.texa
4、sheartinstitute.org /HIC/Topics/Diag/diangio.cfm. Accessed June 14, 2007.,右冠状动脉粥样硬化,吸烟使心血管疾病雪上加霜！,吸烟使冠心病的风险倍增,a All rates were age-adjusted by 10-year age groups to the US white male population in 1980. Hypercholesterolemia defined as cholesterol 250 mg/dL. Hypertension defined as a diastolic blood
5、pressure 90 mm Hg. Burns. Prog Cardiovasc Dis. 2003;46(1): 11-29; Source: Pooling Project Research Group, 1978.,A+B或A+C,进入研究之初危险因素情况,B+C,A+B+C,A、B、C任一项,无危险因素,冠心病发生率,/1000人,A：吸烟 B：胆固醇升高 C：高血压,主动脉粥样硬化的风险随吸烟量增加,aThe probability of an event (developing a disease) occurring in exposed people compared wit
6、h the probability of the event in nonexposed people. Adjusted for age, systolic blood pressure, serum total cholesterol, Quetelet index, diabetes mellitus, menopausal status, alcohol consumption, use of replacement estrogens, and duration of follow-up.Witteman et al. Circulation. 1993;88(part 1):215
7、6-2162.,不吸烟者,1 至 9,10 至 19,20,吸烟者每日吸烟量（支）,冠心病死亡率的增加与吸烟率直接相关,a The probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people. Adjusted for age.Willett et al. N Engl J Med. 1987;317(21):1303-1309.,致死冠心病的相对风险,1-14/日,非吸烟者,1
8、5-24/日,25/日,吸烟者每日吸烟量,相对风险 可信区间,95,心绞痛的风险与吸烟量直接相关,aThe probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people. Adjusted for age.Willett et al. N Engl J Med. 1987;317(1):1303-1309.,1.0,1.6,2.6,2.0,1-14/日,非吸烟者,15-24/日,2
9、5/日,吸烟者每日吸烟量,相对风险 可信区间,95,吸烟增加心源性猝死的风险,aThe probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people. Adjusted for age.Wannamethee et al. Circulation. 1995;91:1749-1756.,1.0,2.3,0.0,1.0,2.0,3.0,4.0,不吸烟者,吸烟者,吸烟使冠状动脉介入治疗
10、后发生Q波心梗的风险增高,aThe probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people. Adjusted for the baseline variables significantly associated with each end point. Hasdai et al. N Engl J Med. 1997;336:755-761.,Q波心梗 (MI),1.0,
11、1.28,2.08,0.0,1.0,2.0,3.0,4.0,不吸烟者,戒烟者,吸烟者,1.0,1.28,2.08,吸烟使血管手术后的死亡率增加,为了提供最新的生存资料， Kazmers等人对310位择期进行血管手术的患者进行了评估 随访时间为 6.644.62年 年龄、糖尿病、吸烟以及较低的射血分数是术后死亡率的独立相关危险因素,Kazmers et al. J Surg Res. 2002;105:109-114.,戒烟使心血管疾病患者受益！,美国NCCP公布前三位有效的临床预防措施,高危人群服用阿司匹林 儿童疫苗接种 戒烟 4 直肠癌筛查 5 高血压筛查 6 流感疫苗接种,3,2,1,1,
12、2,3,Michael V. et al.Am J Prev Med 2006,戒烟给心血管系统带来的益处,短期益处 纤维蛋白原浓度下降 纤维蛋白原合成速率减低 白细胞计数下降 高密度/低密度脂蛋白比例改善 卒中风险降低 高密度脂蛋白增加 低密度脂蛋白下降 动脉压 心率下降 动脉顺应性改善 心梗后心律失常所致猝死风险减低 血小板体积减小 血小板环磷酸腺苷反应增强，促使前列腺素E1 发生腺苷酸环化 吸烟导致的血小板聚集减少,长期益处 减少下列风险 卒中 重复冠脉搭桥术 心梗后反复发生冠脉事件 心梗后心律失常所致猝死 继发心血管疾病 冠脉搭桥术后血运重建术 减少 冠脉搭桥术后的死亡率 经皮冠状动脉
13、成形术后死亡率 与心血管疾病进展相关的炎症标志分子水平(C反应蛋白, 白细胞, 纤维蛋白原),Twardella et al. Eur Heart J. 2004;25:2101-2108; Morita et al. J Am Coll Cardiol. 2005;45:589-594; Oren et al. Angiology. 2006;57:564-568; Terres et al. Am J Med. 1994; 97:242-249; Nilsson et al. J Int Med. 1996; 240:189-194; Peters et al. J Am Coll Car
14、diol. 1995;26:1287-1292; Rea et al. Ann Intern Med. 2002;137: 494-500; Hasdai et al. N Engl J Med. 1997;336:755-761; van Domburg et al. J Am Coll Cardiol. 2000; 36:878-883; Bakhru et al. PLoS Med. 2005;2:e160; Eliasson et al. Nicotine Tob Res. 2001;3:249-255; Hunter et al . Clin Sci. 2001;100:459-46
15、5; Wannamethee et al. JAMA. 1995;274:155-160.,戒烟是冠心病强效干预措施,Critchley JA, Capewell S. JAMA; 2003; 290: 86-97,为什么戒烟这么难？,吸烟者想戒烟但成功比例低,每年只有近23%的人成功戒烟3,每年的戒烟者比例,Bridgwood et al. Living in Britain: Results for the 1998 General Household Survey 1998. West. Getting serious about stopping smoking a review of
16、 products, services, and techniques. No Smoking Day 1997. Arnsten JH. Prim Psychiatry. 1996;3:27-30.,戒烟难，还在于戒断后容易复发,U.S. Department of Health and Human Services. The Health Consequences of Smoking; Nicotine Addiction. A report of the Surgeon General. DHHS Publication No.(CDC)88-8406,1988,信从转变观念开始烟草依赖不只是一种个人习惯， 而是一种明确界定的慢性病。,1998年
