Design of prospective study of acute coronary syndrome hospitalization after smoking ban in public places in Hyogo prefecture: Comparison with Gifu,a prefecture without a public smoking ban

BackgroundHyogo is the second prefecture, after Kanagawa, to enact a smoking ban in public places in Japan. The effect of this smoking ban on acute coronary syndrome (ACS) has not been evaluated.PurposeChanges in the annual number of ACS hospital cases in Hyogo Prefecture, before and after the enactment of the prefectural legislative ban on smoking in public places, are to be compared with those in Gifu Prefecture, where there is no smoking-ban legislation.MethodsConsecutive Hyogo residents with ACS, admitted to 33 major hospitals in the Hanshin-Awaji-Kobe district, which covers 56% of the population, during the 12 months before implementation of the legislation (April 2012 through March 2013) and during the same 24 months thereafter (April 2013 through March 2015) will be enrolled. Consecutive patients with ACS, who are Gifu residents, treated at the 20 major hospitals in Gifu Prefecture will be enrolled as geographical controls. The primary endpoint is the change in number of ACS admissions from April 2012 through March 2015, considering the periods before and after the smoking-ban legislation in Hyogo prefecture.ConclusionOur study has certain strengths: (1) This is the first large Japanese study of ACS registry with smoking-ban legislation. (2) Major hospitals in the Hanshin-Awaji-Kobe district are included. (3) The data will cover 3 years including 1 year before legislation enactment. (4) The data will be compared with those of Gifu Prefecture, where smoking-ban legislation will not be enacted. (5) The very large database makes possible analysis of subgroups based on age and gender.     

酒石酸伐尼克兰片戒烟的疗效和安全性评价

目的 评价酒石酸伐尼克兰片1 mg(2次/d)戒烟疗效和安全性.方法 采用前瞻性、随机、双盲、安慰剂对照设计,比较酒石酸伐尼克兰片和安慰剂从第9周到第12周的4周持续戒烟率、从第9周到第24周的持续戒烟率、第12周和第24周的7d时点戒烟率、第24周的4周时点戒烟率.结果 ①9到12周的持续戒烟率、9到24周的长期戒烟率及第12周的7d时点戒烟率治疗组高于安慰剂对照组(P＜0.05),第24周的7d时点戒烟率和第24周的4周时点戒烟率两者无显著差异(P＞0.05).②酒石酸伐尼克兰片的主要不良事件是集中在胃肠道方面,并未观察到与酒石酸伐尼克兰片直接相关严重不良事件.结论 酒石酸伐尼克兰片剂根据推荐剂量(1 mg,2次/d,12周)使用时,戒烟疗效优于安慰剂,并未发现有明显的安全性问题.     

戒烟门诊强化心理行为干预的临床戒烟效果

目的 探讨戒烟门诊应用伐尼克兰联合强化心理行为干预的临床戒烟效果以及分析戒烟成功预测指标.方法 将2009年3月至2010年9月复旦大学附属中山医院“吸烟及其相关疾病门诊”进行戒烟咨询和干预者作为研究对象,筛选合适对象,分为加强随访组和普通随访组,主要观察第9～12周持续戒断率,应用logistic回归模型进行戒烟成功预测指标分析.结果 戒烟门诊烟草依赖患者应用伐尼克兰联合强化干预治疗第9～12周持续总体戒断率为52.3％,加强随访组60.9％ (28/46),普通随访组46.2％ (30/65),主要不良反应为恶心(39.6％,44/111),睡眠差和梦境异常(17.1％,19/111),均可耐受,戒断症状少.戒烟准备程度和服药时间可作为戒烟成功预测指标.结论 伐尼克兰联合心理行为干预临床戒断率高,强化心理行为干预更明显增加成功率,是戒烟门诊很好的治疗方案,充分戒烟准备和规律足疗程服药能进一步提高戒烟成功率.     

戒烟药物的研究和应用进展

吸烟是引发许多疾病的重要危险因素,戒烟是减少烟草相关疾病的重要手段。戒烟药物有助于吸烟者戒烟。常用一线戒烟药物包括尼古丁替代疗法(NRT)制剂、安非他酮缓释制剂和伐尼克兰。该文对以上戒烟药物的研究和应用进展进行综述。     

Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack

Objective Risk factor modification is key to preventing subsequent cardiac events after a heart attack. This study was designed to investigate the disparity between preventive guidelines and clinical practice among smoking patients. Methods The study was carried out in smokers admitted with myocardial infarction (MI). A total of 275 patients who had been regularly followed for over one year after MI were randomly selected and enrolled in this study. We investigated changes in smoking behavior and the adherence rate to ACC/AHA Guidelines for secondary prevention in patients with coronary artery disease at the time of, and one year after, the index event. Results The study population consisted of 275 patients (97.1% males) with a mean age of 57.0 ± 11.2 years. Achievement of target goals at one year was as follows: smoking cessation, 52.3%; blood pressure, 83.9%; HbA1c, 32.7%; lipid profile, 65.5%; and body mass index (BMI), 50.6%. Over one year, 80% of the patients attempted to quit smoking; 27% of them re-started smoking within one month after discharge while 65% succeeded in cessation of smoking. At one year, only 52% of the patients overall had stopped smoking. From the multivariate logistic analysis including smoking patterns and clinical characteristics, the severity of coronary artery disease was the only independent predictor for smoking cessation (Relative risk (RR): 1.230; P = 0.022). Conclusions Only a small percentage of MI patients adhere to guidelines for secondary prevention and a sizable proportion fail to stop smoking. These findings underscore the need for an effective patient education system.     

Psychological distress related to smoking cessation in patients with acute myocardial infarction

Among all causes of preventable deaths, smoking is responsible for the greatest number of deaths worldwide and predisposes to fatal, noncommunicable diseases, especially cardiovascular diseases. Lifestyle changes are effective in the treatment of patients with smoking-related diseases and assist in the prevention of premature mortality. Our objective was to investigate the available scientific evidence regarding the psychological distress related to smoking cessation in patients who have had acute myocardial infarction. To that end, we conducted an integrative review of the literature in order to summarize relevant studies on this topic. The selected databases were Scopus, PubMed Central, Institute for Scientific Information Web of Science (Core Collection), ScienceDirect, EMBASE, SciELO, LILACS e PsycINFO. On the basis of the inclusion and exclusion criteria adopted for this study, 14 articles were selected for analysis. Those studies showed that the prevalence of psychological distress is higher among smokers than among nonsmokers, and distress-related symptoms are much more common in smokers with acute myocardial infarction than in those without. Smoking cessation depends on the active participation of the smoker, whose major motivation is the underlying disease. Most studies have shown that there is a need to create treatment subgroups as a means of improving the treatment provided. This review article expands the knowledge regarding smoking cessation and shows the need to invest in future research that investigates subgroups of smokers diagnosed with the major smoking-related comorbidities, such as acute myocardial infarction, in order to develop specific interventions and psychological support strategies.     

Reduced life expectancy after an incident hospital diagnosis of acute myocardial infarction — Effects of smoking in women and men

Background

The aim was to investigate possible gender differences in the years of life lost after acute myocardial infarction (MI) and to explore how smoking affects life expectancy in the two genders.

Methods

In the years 1998–2005, 2281 patients (36.8% women) who were discharged from or died in hospital following a diagnosis of MI were included. Survivors were followed for a mean of 8 years. The age of death for each patient was subtracted from the average projected age of death for individuals in the general population with a similar age to the patient at the time of their MI. The effects of gender, smoking, and other risk factors on the years of life lost were analysed.

Results

During follow-up, 55% of the patients died. Non-smokers, ex-smokers and current smokers lost 5.4, 6.4 and 10.3 years of life, respectively. Structural equation modeling showed that currently smoking men lost 4.2 more years more than did non-smoking men (P < 0.001), and this was mediated through more prematurely occurring MIs. Female current smokers lost 1.9 years more than male current smokers and female ex-smokers lost 1.8 years more than male ex-smokers (both P < 0.001).

Conclusions

MI caused a substantial number of years of life lost, with a heavier loss in current smokers than in ex-smokers and non-smokers. The effect was predominantly related to the patient's age at the event. More years of life were lost among smoking women than among smoking men, indicating that smoking is most detrimental for the female gender.     

吸烟和戒烟对冠状动脉旁路移植术后远期结果的影响

目的 探讨吸烟和戒烟对冠状动脉旁路移植术(CABG)后远期结果的影响。方法 随访2004年1月1日至2005年12月30日在阜外心血管病医院行CABG的患者2541例。根据术前有无吸烟史,将患者分为不吸烟组和吸烟组,吸烟组又进一步分为术前戒烟亚组,术后戒烟亚组,持续吸烟亚组。观察患者的死亡、主要不良心脑血管事件以及心绞痛的发生情况。采用Cox回归模型分析各组患者发生不良事件的风险。结果 随访4.27 ～6.41年（平均随访5.09年）。CABG术后持续吸烟患者的比例为22.1％。Cox多因素回归分析显示：与不吸烟组比较,吸烟组肿瘤原因死亡(RR：2.38,95％ CI:1.06 ～5.36)、主要不良心脑血管事件（RR:1.26,95％ CI:1.01 ～ 1.57）和心绞痛（RR：1.29,95％CI:1.04 ～ 1.59)的发生风险较高;与不吸烟组比较,持续吸烟亚组全因死亡(RR:2.60,95％ CI:1.53～4.46)、心因死亡（RR:2.51,95％ CI:1.32～4.78）、肿瘤原因死亡（RR:5.12,95％ CI:2.08 ～12.59）、主要不良心脑血管事件（RR:1.83,95％ CI:1.42 ～2.34）和心绞痛(RR:1.69,95％ CI:1.33 ～2.16)的发生风险较高;术前戒烟亚组和术后戒烟亚组的死亡、主要不良心脑血管事件和心绞痛的发生风险与不吸烟组相似（均P＞ 0.05）。结论 CABG术后患者持续吸烟比例较高。CABG术后持续吸烟会增加死亡率,主要不良心脑血管事件和心绞痛发生率,戒烟可减少不良事件的发生。     

Effects of age, sex and smoking on ankle-brachial index in a Finnish population at risk for cardiovascular disease

BACKGROUND

Smoking is a well-known risk factor for peripheral arterial disease (PAD). Data regarding differences in the prevalence of PAD between sexes are somewhat controversial. In addition, most studies indicate that the prevalence of PAD increases with age in both sexes. In the present study, the effects of sex, age and smoking on the ankle-brachial index (ABI) in a Finnish cardiovascular risk population were investigated.

OBJECTIVES

To investigate the relationship between the ankle-brachial index, and age, sex and smoking in a Finnish population at risk for cardiovascular disease.

METHODS

All men and women between 45 and 70 years of age living in a rural town (Harjavalta, Finland; total population 7700) were invited to participate in a population survey (Harmonica study). Patients with previously diagnosed diabetes or vascular disease were excluded. In total, 2856 patients were invited to participate in the study. From these subjects, a cardiovascular risk population was screened. Complete data were available from 1028 persons. ABI (the ratio between the posterior tibial or dorsalis pedis artery and brachial artery pressures) was measured, and questionnaires were used to detect smoking status and relevant medical history. Only current smoking status was taken into account.

RESULTS

The mean ABI for the entire study population was 1.10 (range 0.56 to 1.64). Current smokers had a lower mean ABI (1.06; P<0.001). There was no statistically significant difference in ABI values among age groups, although the majority of patients with ABI values below 0.9 were older than 60 years of age. There was no statistically significant difference in ABI between sexes.

CONCLUSION

As previously reported, the present study shows the significant effect of smoking in the development of PAD. No statistically significant difference was found among age groups, but the tendency was toward lower ABIs in the oldest age groups. Sex had a minimal effect on the ABI.     

冠状动脉旁路移植术后患者吸烟及戒烟依从性影响因素调查

目的 探讨影响冠状动脉旁路移植术后患者吸烟及戒烟依从性的相关因素.方法 以问卷调查的方式,对在北京大学人民医院心脏中心接受冠状动脉旁路移植术,并于2008年10月至2009年1月期间在门诊复查的160例冠心病患者进行吸烟及戒烟依从性影响因素调查.将其中问卷填写完整的153例患者分为不吸烟组(72例)和吸烟组(81例),并进行统计分析.结果 不吸烟组对于吸烟危害他人健康认知的比例高于吸烟组(100%比91.4%,P=0.011),不吸烟组对于吸烟与慢性阻塞性肺疾病相关认知的比例也高于吸烟组(80.6%比60.5%,P=0.007),而吸烟组对于吸烟与缺血性心脏病相关认知的比例高于不吸烟组(61.7%比40.3%,P=0.008).吸烟组从朋友同事中获得吸烟及戒烟相关知识和从医护人员中获得吸烟及戒烟相关知识的比例均高于不吸烟组[分别为22.2%比8.3%(P=0.018)和55.6%比26.4%(P=0.000)].吸烟组中,已戒烟患者68例(84.0%),未戒烟患者13例(16.0%).戒烟患者的戒烟依从性比例及家庭成员对患者的戒烟支持比例均高于未戒烟患者[分别为82.4%比38.5%(P=0.001)和94.1%比61.5%(P=0.003)].未戒烟患者术后尼古丁依赖评分较术前显著减低(3.77±2.31比2.46±2.30,P=0.008).结论 冠状动脉旁路移植术后患者对吸烟与冠心病和其他疾病的关联性存在不同程度的认知缺乏.医护人员对患者的戒烟宣教和家庭成员的支持是促使患者成功戒烟的重要因素.

Abstract：

Objective To analyze the underlying factors related to smoking and cessation compliance in patients following coronary artery bypass graft surgery (CABG). Methods From October,2008 to January, 2009, a total of 160 CABG patients received questionnaires concerning smoking and smoking cessation compliance in Peking university people's hospital, 153 patients completed the questionnaires and were divided into non-smoking (72 patients) and smoking group (81 patients). Results Cognition was better in non-smokers than smokers on smoking-related health hazards ( 100% vs. 91.4%,P =0. 011 ) and on the relationship between smoking and chronic obstructive pulmonary diseases (80. 6%vs. 60. 5%, P =0. 007) while cognition was better in smokers than non-smokers on the relationship between smoking and ischemic heart disease (61.7% vs. 40. 3% ,P=0. 008). Compared with non-smoker,smokers acquired significantly more knowledge on smoking and smoking cessation from friends and colleagues (22.2% vs. 8.3%,P=0.018) and from medical professionals (55.6% vs. 26.4% ,P=0.000). In the smoking group, 68 patients quit smoking (84.0%), while the remaining 13 patients failed to quit smoking (16.0%) post CABG. The smoking cessation patients were superior to the smoker patients on smoking cessation compliance (82.4% vs. 38. 5%, P =0.001 ) and support from family members (94. 1% vs.61.5%, P =0. 003). The nicotine dependence scores of current smokers significantly declined after CABG (preoperative3.77±2.31 vs. postoperative 2.46 ±2.30, P=0. 008 ). Conclusions Cognition on the relationship between smoking and coronary heart disease as well as other diseases should be improved in patients underwent CABG. Medical staff and family members play an equal important role on improving the smoking cessation rate for patients post CABG.     

Clinical presentation and short-term outcome of acute coronary syndrome in native young Saudi population

ObjectivesTo investigate acute coronary syndromes (ACS) in the young Saudi population in Aseer Region, southwestern Saudi Arabia.Materials and methodsWe retrospectively reviewed our database between January 2006 and May 2009, 924 patients were diagnosed to have ACS. Among them 107 patients (11.6%) met our definition of young [66 (61.7%) male < 45 years, and 41 (38.3%) female < 55 years]. We compared this study population to a control group of 50 elderly patients consecutively enrolled in a contemporary period.ResultsThe overall age was 42.3 ± 7.9 and 68.7 ± 10.1 years in the study population and control respectively. 100% of the population and 92% of the control group presented with chest pain. Diabetes mellitus (DM) prevalence was 46.7% in the study population (63.4% in females), and 62% in the control group. Hypertension, smoking, dyslipidemia and overweight/obesity were reported in 31.8%, 25.2%, 21.5% and 44.9% of the study population and 58%, 6%, 26% and 42% of the control group, respectively. Past history of coronary artery disease was documented in 16.8% of the study population and 38% of the control group. The discharge diagnoses were ST-segment elevation myocardial infarction (STEMI) in 41 (38.3%) (representing 4.4% of the whole ACS population) and 11 (22%) patients of the study population and control group respectively, non-ST-segment elevation myocardial infarction in 36 (33.6%) and 23 (46%) patients of the study population and control group, respectively, and unstable angina in 30 (28.0%) and 15 (30%) patients of the study population and control group, respectively. Coronary angiography was performed in 86 (80.4%) and 41 (82%) patients in the study population and control group respectively. In hospital, one young patient had acute ischemic stroke and one elderly patient died, 22.4% of the study population and 32% of control group were discharged with clinical diagnosis of heart failure or in need for diuretics.ConclusionIn our study, the young Saudi population with ACS had chest pain as the leading symptom. STEMI was the major final diagnosis and among one of the highest reported worldwide. There is a high prevalence of DM; however, they have favorable in hospital and short-term outcome.     

心肌梗死后患者应用非甾体类抗炎药影响心血管风险的临床分析

目的 评估非甾体类抗炎药(NSAIDs)对心肌梗死后患者心血管事件发生的影响.方法 回顾性分析182例心肌梗死患者的临床资料,依据出院后服药差异分为:观察组,87例,长期服用选择性NSAIDs;对照组,95例,仅服用阿司匹林或氯吡格雷.随访1年后,比较两组患者高血压、接受血运重建术、2级以上心力衰竭以及猝死等心血管事件的发生率;并用Cox风险比例模型分析NSAIDs与心血管事件发生率的相关性.结果 观察组患者高血压、接受血运重建术、2级以上心力衰竭及猝死的发生率显著高于对照组,分别为13.79％(12/87)和9.47％(9/95)、14.94％ (13/87)和10.64％(10/95)、22.99％ (20/87)和12.63％ (12/95)、3.44％ (3/87)和2.10％(2/95,P均＜0.05).服用NSAIDs使心肌梗死后患者心血管事件的发生率显著增加,分别为:高血压(OR=1.48,95％ CI:1.26～ 1.69)、接受血运重建术(OR=1.33,95％CI:1.17 ～ 1.53)、2级以上心力衰竭(OR=1.84,95％ CI:1.49 ～2.06)及猝死(OR=1.42,95％CI:1.29～1.68).结论 心肌梗死后患者服用选择性NSAIDs会显著增加患者心血管事件发生风险.     

吸烟对国人血清对氧磷酶活性的影响

目的 :分析吸烟对中国人对氧磷酶 (PON)活性的影响。方法 :36 7例冠心病患者和 15 9例相匹配的健康人根据吸烟情况分别分为吸烟、不吸烟及戒烟 (A、B、C) 3个组 ,其中C组又根据戒烟时间长短分为C1、C2、C33个亚组 ,并分别用醋酸苯酯法检测各自的PON活性。结果 :吸烟降低了PON活性 [A组、B组、C组PON活性分别为 (91± 5 8)、(131± 73)、(112± 6 6 )kU /L ,P <0 .0 5 ],但其影响是较短时期的 ,PON活性的恢复与戒烟时间存在相关性。结论 :吸烟是冠心病的高危因素 ,其发病机制之一可能与它降低了PON的活性有关。     

Increased Risk of Acute Myocardial Infarction in Systemic Sclerosis: A Nationwide Population-based Study

Purpose

Systemic sclerosis is a life-threatening autoimmune disease characterized by vasculopathy, which results in myocardial involvement in an extremely high percentage of patients. Nevertheless, there have been no large-scale epidemiological studies about the risk of acute myocardial infarction in patients with systemic sclerosis. The aims of this study were to evaluate the hazard ratio (HR) and risk factors of acute myocardial infarction in patients with systemic sclerosis, as well as to compare the risks of acute myocardial infarction among systemic sclerosis patients taking different immunosuppressors.

Methods

The study cohort included 1344 patients with systemic sclerosis and 13,440 (1:10) age-, sex-, and comorbidity-matched controls during the period between 1997 and 2006, from the National Health Insurance Research Database. We compared the risk of acute myocardial infarction between patients with systemic sclerosis and controls and calculated the adjusted HRs for acute myocardial infarction in systemic sclerosis patients taking immunosuppressors and not taking immunosuppressors.

Results

The incidence rates of acute myocardial infarction were 535 and 313 cases per 100,000 person-years for systemic sclerosis cohort and reference cohort, respectively (P <.001, unadjusted). After adjusting for age, sex, and underlying medical diseases on Cox proportional hazards model, systemic sclerosis was found to be an independent risk factor for acute myocardial infarction (HR 2.45). Other risk factors included hypertension (HR 2.08) and diabetes (HR 2.14). The multivariate adjusted HR for acute myocardial infarction did not decrease among the systemic sclerosis patients taking systemic steroids, penicillamine, cyclophosphamide, azathioprine, methotrexate, or cyclosporine.

Conclusion

Systemic sclerosis is independently associated with an increased risk of acute myocardial infarction. Immunosuppressors do not lower the risk of acute myocardial infarction in our study.     

心肌梗死部位与危险因素及预后的相关性探讨

急性心肌梗死的部位是决定心肌梗死预后的重要因素,为此作者研究了１７９例急性前壁和下壁心梗（包括非Ｑ波性心梗）梗死部位与危险因素的差别及对住院病死率和并发症的影响。本文结果提示前壁心梗患者中,不吸烟者较下壁心梗患者中多,且前壁心梗患者中有高血压和高血脂者多,机械并发症多,预后差,病死率高。房室传导阻滞多见于下壁心梗,非Ｑ波心梗并发症少于有Ｑ波心梗患者。     

Behavioural interventions for smoking cessation in patients hospitalised for a major cardiovascular event

The impact of cigarette smoking on progression of atherosclerosis in patients with known cardiovascular disease suggests a strong need for effective cessation interventions in this group. This letter compares and discusses smoking cessation outcomes following behavioural smoking cessation interventions versus usual care in hospitalised cardiovascular patients using meta-analysis of randomised controlled peer-reviewed publications. It particularly focuses on the impact of intensity and duration of intervention on outcome.