吸烟与心血管疾病心血管网先心病高血压冠心病血管疾病心房颤动.ppt

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1、中国NEHNS IV由吸烟引起死亡的前三位疾病：由吸烟引起死亡的前三位疾病：国外资料为：国外资料为：COPDCOPD冠心病肺冠心病肺CaCa国内资料为：国内资料为：COPDCOPD肺肺CaCa冠心病冠心病1.Surgeoen Generals Report.Health Consequences of Smoking;2004.2.J Natl Cancer Inst.1993;85(24):1994.3.Crane.Cancer Epidemiol Biomarkers Prev.1996;5(8):639.4.Miligi.Am J Ind Med.1999;36(1):60.5.Roma

2、n.Cerebrovasc Dis,2005;20(Suppl 2):91.6.Willigendael.J Vasc Surg.2004;40:1158.7.Yang.BMJ.1999;319:143Lavi et al.Circulation.2007;115:2621-2627;http:/www.texasheartinstitute.org/HIC/Topics/Diag/diangio.cfm.Accessed June 14,2007.右冠状动脉粥样硬化右冠状动脉粥样硬化Sambola et al.Circulation.2003;107:973-977.Factor Xa(FX

3、a)pmol/L/minP=.0032172830100200300400吸烟者吸烟前（2支烟）吸烟者吸烟后(2支烟)Barua et al.Circulation.2001;104:1905-1910.50000不吸烟者吸烟者4000300020001000NO浓度浓度(nmol/L)P.000112663613Zeiher et al.Circulation.1995;92:1094-1100.020304060501010P.01P.001P.01吸烟者吸烟者P.01不吸烟者不吸烟者P.01动脉造影正常的吸烟者动脉造影不正常的吸烟者动脉造影正常的不吸烟者动脉造影不正常的不吸烟者流量调节的

4、内皮血管舒张功能流量调节的内皮血管舒张功能Lavi et al.Circulation.2007;115:2621-2627.P=.03604530150不吸烟者戒烟者吸烟者46%34%35%内皮功能障碍内皮功能障碍Lavi et al.Circulation.2007;115:2621-2627;Stewart et al.Circulation.2005;111:1756-176286420P.0001P=.03P.0001P.0001吸烟者戒烟者白细胞中性粒细胞淋巴细胞单核细胞不吸烟者细胞计数细胞计数109/Lns=not significant.a Unless marked as“n

5、s,”differences for each value between groups were statistically significant at a level of P.05.Schmid et al.Thromb Res.1996;81:451-460.不吸烟者吸烟者pg/mLa36.834.832.830.828.826.824.822.8123451211-脱氢血栓烷素脱氢血栓烷素B2 nsnsnsMin/10 Plateletsa1234512丙二醛丙二醛天天5.62.53.23.64.04.44.85.2nsnsnsnsnsnsnsnsnsns天天异构前列腺素F2 水平

6、是体内脂质过氧化反应的指标The dots representing subjects who smoked are each connected to a dot representing a nonsmoker matched to the subject for age and sex.Adapted from Morrow et al.N Engl J Med.1995;332(18):1198-1203.64056048040032024016080吸烟者不吸烟者1000900800700600500400300吸烟者不吸烟者自由异构前列腺素自由异构前列腺素F2pmol/L酯化异构前

7、列腺素酯化异构前列腺素F2pmol/L吸烟流行吸烟流行10年后出现吸烟相关疾病的流行年后出现吸烟相关疾病的流行Waters et al.Circulation.1996;94:614-621.已有病变加重的发生率已有病变加重的发生率吸烟者非吸烟者新病变发生率新病变发生率吸烟者P=.002P=.007非吸烟者患者百分率患者百分率aThe probability of an event(developing a disease)occurring in exposed people compared with the probability of the event in nonexposed p

8、eople.Adjusted for age.Willett et al.N Engl J Med.1987;317(1):1303-1309.吸烟者每日吸烟量吸烟者每日吸烟量相对风险可信区间95aThe ratio of the odds of development of disease in exposed persons to the odds of development of disease in nonexposed persons.Teo.Lancet.2006;368:647-658.风险比可信区间95Y usuf S et al.Lancet.2004;364:937-52

9、OR (99%CI)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.吸烟者每日吸烟量吸烟者每日吸烟量相对风险可信区间95aThe probability of an event(developing a disease)occu

10、rring in exposed people compared with the probability of the event in nonexposed people.Adjusted for age.Wannamethee et al.Circulation.1995;91:1749-1756.1.02.30.01.02.03.04.0不吸烟者吸烟者相对风险可信区间95aThe probability of an event(developing a disease)occurring in exposed people compared with the probability o

11、f 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波心梗波心梗(MI)相对风险可信区间950.01.02.03.04.0不吸烟者戒烟者吸烟者Adjusted for age,systolic blood pressure,diastolic blood pressure,total cholesterol,HDL cholester

12、ol,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 upper three quarters of cotinine concentration combined(0.8 to 14.0 ng/mL).cLight

13、passive refers to lowest quarter of cotinine concentration among nonsmokers(0-0.07 ng/mL).Whincup et al.BMJ.2004;329:200-205.随访时间（年）随访时间（年）0510152000.050.100.150.20轻度主动吸烟轻度主动吸烟a重度被动吸烟重度被动吸烟b轻度被动吸烟轻度被动吸烟c严重冠心病发生比例aThe ratio of the odds of development of disease in exposed persons to the odds of devel

14、opment of disease in nonexposed persons.Adjusted for age,sex,region,physical activity,and consumption of fruits,vegetables,and alcohol.Adapted from Teo et al.Lancet.2006;368:647-658.比值比可信区间95脑核磁共振像脑核磁共振像 急性缺血性脑卒中急性缺血性脑卒中Goldstein et al.Stroke.2006;37:1583-1633;http:/www.ucihs.uci.edu/stroke/whatisas

15、troke.shtml.Accessed October 19,2007.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 smoke.Howard et al.JAMA.1998;279(2):119-124.吸烟者不吸烟

16、者且无被动吸烟b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,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）吸烟者每日吸烟量（支）相对风险可信区间95aThe probability of an event(developing a disease)occurring in exposed people comp