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1、吸烟与心血管疾病吸烟是中国人心血管疾病的重要危险因素高血压 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中国NEHNS IV冠心病是吸烟致死疾病的前三位之一由吸烟引起死亡的前三位疾病：国外资料为：COPD冠心病肺Ca国内资料为：COPD肺Ca冠心病1. Surgeoen Generals Report. Health Consequences of Smoking; 2004. 2. J Natl Cancer Inst. 1993;85(24):1994. 3. Crane. Cancer Epidemiol Biomar
2、kers Prev. 1996;5(8):639. 4. Miligi. Am J Ind Med. 1999;36(1):60. 5. Roman. Cerebrovasc Dis, 2005;20(Suppl 2):91. 6. Willigendael. J Vasc Surg. 2004;40:1158. 7. Yang. BMJ. 1999;319:143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.texasheartinstitute.org/HIC/Topics/D
3、iag/diangio.cfm. Accessed June 14, 2007.右冠状动脉粥样硬化吸烟促发心血管疾病的发病机理组织因子（TF）在动脉粥样 硬化斑块有高表达，这可能 在血栓形成中发挥重要作用 TF 水平以 Xa因子 (FXa)进行 评价 吸烟者与非吸烟者比，循环 中TF活性远高于后者Sambola et al. Circulation. 2003;107:973-977.Factor Xa (FXa) pmol/L/minP=.0032172830100200300400吸烟者吸烟前（2支烟）吸烟者吸烟后(2支烟)吸烟使血栓生成增加Barua et al. Circulation
4、. 2001;104:1905-1910.50000 不吸烟者吸烟者4000300020001000NO浓度 (nmol/L)P70 y 70 y 支支/ /日日 2020非吸烟者非吸烟者戒烟者戒烟者1-191-19支支/ /日日风 险 比可 信 区 间95吸烟增加急性非致死性心梗的风险Y usuf S et al . Lancet. 2004;364:937-52OR (99% CI)每日吸烟量与心肌梗死发生有量效关系a The probability of an event (developing a disease) occurring in exposed people compare
5、d 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致死冠心病的相对风险1-14/1-14/日日非吸烟者非吸烟者15-24/15-24/日日 25/25/日日 吸烟者每日吸烟量相 对 风 险可 信 区 间95吸烟增加冠心病死亡风险aThe probability of an event (developing a disease) occurring in exposed
6、people compared with the probability of the event in nonexposed people. Adjusted for age. Wannamethee et al. Circulation. 1995;91:1749-1756.1.02.30.01.02.03.04.0不吸烟者吸烟者相 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 probab
7、ility 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)1.01.01.281.282.082.08相 对 风 险可 信 区 间950.01.02.03.04.0不吸烟者戒烟者吸烟者吸烟使冠脉介入治疗后发生Q波心梗的风险 增高被动吸烟与冠心病Adjusted for age, systolic blo
8、od pressure, diastolic blood pressure, total cholesterol, HDL cholesterol, FEV, height, preexisting CAD, body mass index, triglycerides, white cell count, diabetes, physical activity, alcohol intake, and social class. aLight active refers to men smoking 1-9 cigarettes a day. bHeavy passive refers to
9、 upper three quarters of cotinine concentration combined (0.8 to 14.0 ng/mL). cLight passive refers to lowest quarter of cotinine concentration among nonsmokers (0-0.07 ng/mL). Whincup et al. BMJ. 2004;329:200-205. 被动吸烟发生心脏疾病的风险比不吸烟者增加被动吸烟发生心脏疾病的风险比不吸烟者增加3030随访时间（年）0510152000.050.100.150.20轻度主动吸烟a重度
10、被动吸烟b轻度被动吸烟c严 重 冠 心 病 发 生 比 例被动吸烟增加冠心病发生风险aThe ratio of the odds of development of disease in exposed persons to the odds of development of disease in nonexposed persons. Adjusted for age, sex, region, physical activity, and consumption of fruits, vegetables, and alcohol. Adapted from Teo et al. Lan
11、cet. 2006;368:647-658.被动吸烟暴露持续时间（小时被动吸烟暴露持续时间（小时/ /周）周）无无1-71-78-148-1415-2115-21 22224 42 21 10.750.75 被动吸烟使发生非致死性心梗的风险量级增加被动吸烟使发生非致死性心梗的风险量级增加比 值 比可 信 区 间95被动吸烟增加急性心梗发生风险吸烟与脑卒中大量吸烟后急性作 用：脑血管急性血栓形 成脑核磁共振像 急性缺血性脑卒中Goldstein et al. Stroke. 2006;37:1583-1633; http:/www.ucihs.uci.edu/stroke/whatisastro
12、ke.shtml. Accessed October 19, 2007.吸烟增加急性缺血性卒中风险无论论是主动还动还 是被动动吸烟都会加快颈动颈动 脉粥样样硬化aAdjusted for demographic characteristics, cardiovascular risk factors, and lifestyle variables (risk factor model and Keys score, education, leisure activity, body mass index, and alcohol use). bTo environmental tobacco
13、 smoke. Howard et al. JAMA. 1998;279(2):119-124.吸烟者不吸烟者且无 被动吸烟b43.043.038.838.831.631.632.832.825.925.9不吸烟者但有 被动吸烟b戒烟者且无被 动吸烟b戒烟者有被动 吸烟b颈 动 脉 内 膜 中 层 厚 度 增 加m/3年吸烟促进颈动脉粥样硬化进展aThe probability of an event (developing a disease) occurring in exposed people compared with the probability of the event in
14、nonexposed people. Adjusted for age, follow-up period, history of diabetes, hypertension, high cholesterol levels, and relative weight (in 5 categories). Colditz et al. N Engl J Med. 1988;318(15):937-941.1-1415-24不吸烟者25吸烟者每日吸烟量（支）相 对 风 险可 信 区 间95青年、中年女性，发生脑卒中的风险可能与吸烟量相关吸烟增加致命性和非致命性脑卒中风险aThe probabil
15、ity of an event (developing a disease) occurring in exposed people compared with the probability of the event in nonexposed people. Adjusted for age, exercise, alcohol consumption, body mass index, history of hypertension, and history of diabetes. Kurth et al. Stroke. 2003;34:2792-2795.不吸烟者 (n=20,339)每日吸烟量少于15支 (n=1914)每日吸烟量多于15支 (n=3265)总出血性脑卒中脑内出血蛛网膜下腔出血2.062.06 3.433.432.392.392.892.891.741.744.044.04相 对 风 险可 信 区 间95吸烟增加出血性卒中风险aTwenty-year age-adjusted mortality per 10,000 person-years for men. P1-31-35-105-1010-1510-15 2020戒烟者戒烟者 ( (戒烟年数戒烟年数) )3-53-515-2015-204 42 21 1比 值 比可 信 区 间9
