代谢综合征与吸烟的交互作用对心血管事件发生风险的影响  

Impact of the interaction between metabolic syndrome and smoking on the risk of cardiovascular events

作　　者：郑安红 彭年春 张淼 张巧 时立新 胡颖 王睿 何娟 Zheng Anhong;Peng Nianchun;Zhang Miao;Zhang Qiao;Shi Lixin;Hu Ying;Wang Rui;He Juan(Department of Endocrinology and Metabolism,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院内分泌代谢病科,贵阳550004

出　　处：《中华内分泌代谢杂志》2023年第7期581-587,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：贵州医科大学附属医院国家自然科学基金培育计划项目(gyfynsfc-2021-41);2023—2024年度省级医学重点学科主项项目(黔卫健函(2023)2号)。

摘　　要：目的探讨代谢综合征与吸烟的交互作用对后续心血管事件风险的影响。方法选取"中国2型糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究"的贵州地区分队列贵阳市云岩区40岁及以上城区居民, 基线调查始于2011年, 收集基线一般情况(性别、年龄、疾病病史、生活习惯、吸烟状态)及完成代谢综合征(MS)相关生化指标检测;随后对研究对象进行跟踪调查, 同时记录研究对象首次调查后发生的心血管事件, 平均随访(10.07±1.49)年, 采用Cox比例风险模型分析代谢综合征与吸烟的交互作用对后续心血管事件的影响。结果研究共纳入7 275人, 发生心血管事件639人, 在多变量校正后, 与非MS从不吸烟者相比, MS吸烟者表现出更高的心血管事件风险, HR(95%CI)为6.54(4.88, 8.78), 且比MS从不吸者[1.39(1.11, 1.75)]、非MS吸烟者[2.48(1.77, 3.49)]均高, MS与吸烟对心血管事件发生风险存在相加交互作用:RERI(95%CI)为3.30(1.89, 4.70), AP(95%CI)为0.55(0.43, 0.59), S(95%CI)为3.07(1.94, 4.84)。进一步将戒烟时长进行分层, 与吸烟者相比, 不论是否合并MS, 长期戒烟者(≥8年)均表现出更低的心血管事件风险[0.45(0.26, 0.78)、0.42(0.19, 0.95)]。结论 MS与吸烟对心血管事件风险存在相加交互作用, 两者并存显著增加心血管事件的发生风险。Objective To investigate the effect of the interaction between metabolic syndrome and smoking on the risk of subsequent cardiovascular events.Methods Urban residents aged 40 and above in the Yunyan District of Guiyang City were selected from"Risk Evaluation of cAncers in Chinese diabeTic Individuals:A lONgitudinal(REACTION)Study".The baseline survey started in 2011 and general information including gender,age,medical history,lifestyle habits,and smoking status were collected.Additionally,biochemical indicators related to metabolic syndrome(MS)were measured.The study participants were then followed up,and the first cardiovascular events occurring after the initial survey were recorded.The average follow-up period was 10.07±1.49 years.The interaction between metabolic syndrome and smoking on subsequent cardiovascular events was analyzed using Cox proportional hazards models.Results The study included a total of 7275 individuals,among whom 639 experienced cardiovascular events.After adjusting for multiple variables,compared to non-smokers without metabolic syndrome(MS),smokers with MS showed a higher risk of cardiovascular events,with a hazard ratio(HR)of 6.54(95%CI 4.88,8.78).This risk was higher than that of individuals with MS who never smoked[HR 1.39(95%CI 1.11,1.75)]and non-MS smokers[HR 2.48(95%CI 1.77,3.49)].There was an additive interaction between MS and smoking on the occurrence of cardiovascular events,with a relative excess risk due to interaction(RERI)of 3.30(95%CI 1.89,4.70),an attributable proportion(AP)of 0.55(95%CI 0.43,0.59),and a synergy index(S)of 3.07(95%CI 1.94,4.84).Furthermore,when stratifying the duration of smoking cessation,long-term quitters(≥8 years)showed a lower risk of cardiovascular events compared to current smokers,regardless of whether they had MS.The hazard ratios were 0.45(95%CI 0.26,0.78)for individuals with MS and 0.42(95%CI 0.19,0.95)for individuals without MS.Conclusions There is an additive interaction between smoking and MS on the risk of cardiovascular events.The coexi

关 键 词：代谢综合征 吸烟 心血管事件 交互作用 队列研究 

分 类 号：R589[医药卫生—内分泌] R54[医药卫生—内科学]