Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women

Background

Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear.

Methods

We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses’ Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors.

Results

The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation.

Conclusions

In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.     

Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses' Health Study II

BACKGROUND: Psoriasis is a common, chronic, inflammatory skin disorder. Higher adiposity may increase the risk of psoriasis, but, to our knowledge, no prospective data are available on this relationship. METHODS: We prospectively examined the relationships between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]), weight change, waist circumference, hip circumference, waist-hip ratio, and incident psoriasis in 78 626 women over a 14-year period (1991-2005) in the Nurses' Health Study II. The primary outcome was incident, self-reported, physician-diagnosed psoriasis. RESULTS: During the 14 years of follow-up, there were 892 self-reported incident cases of psoriasis. There was a graded positive association between BMI measured at multiple time points and the risk of incident psoriasis. When we analyzed BMI updated every 2 years, compared with a BMI of 21.0 through 22.9, the multivariate relative risks of psoriasis were 1.40 (95% confidence interval [CI], 1.13-1.73) for a BMI of 25.0 through 29.9; 1.48 (95% CI, 1.15-1.91) for a BMI of 30.0 through 34.9; and 2.69 (95% CI, 2.12-3.40) for a BMI of 35.0 or greater (P for trend, < .001). For BMI at the age of 18 years, the multivariate relative risk for the top BMI category (> or = 30.0) was 1.73 (95% CI, 1.24-2.41) and that for a lower BMI category (< 21.0) was 0.76 (95% CI, 0.65-0.90) (P for trend, < .001). Weight gain from the age of 18 years, higher waist circumference, hip circumference, and waist-hip ratio were all associated with a higher risk of incident psoriasis (all P values for trend, < .001). CONCLUSION: This large prospective study indicates that increased adiposity and weight gain are strong risk factors for incident psoriasis in women.     

Attributable risk estimate of severe psoriasis on major cardiovascular events

Background

Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events, such as myocardial infarction, stroke, and mortality from cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis.

Methods

We performed a cohort study in the General Practice Research Database. Severe psoriasis was defined as receiving a psoriasis diagnosis and systemic therapy (N = 3603). Up to 4 patients without psoriasis were selected from the same practices and start dates for each patient with psoriasis (N = 14,330).

Results

Severe psoriasis was a risk factor for major adverse cardiac events (hazard ratio 1.53; 95% confidence interval, 1.26-1.85) after adjusting for age, gender, diabetes, hypertension, tobacco use, and hyperlipidemia. After fully adjusted analysis, severe psoriasis conferred an additional 6.2% absolute risk of 10-year major adverse cardiac events.

Conclusion

Severe psoriasis confers an additional 6.2% absolute risk of a 10-year rate of major adverse cardiac events compared with the general population. This potentially has important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis. Future prospective studies are needed to validate these findings.     

Parental smoking during pregnancy and offspring cardio-metabolic risk factors at ages 17 and 32

Objective

To examine the association of maternal and/or paternal smoking during pregnancy with offspring cardio-metabolic risk (CMR) factors at adolescence and early adulthood, taking into account socio-demographic, medical and lifestyle characteristics of parents and offspring, as well as offspring common genetic variation.

Methods

We used a population-based cohort of all 17 003 births in Jerusalem during 1974–76, with available archival data on parental and birth characteristics. Measurements at age 17 were assessed at military induction examinations for 11 530 offspring. 1440 offspring from the original 1974–1976 birth cohort were sampled using a stratified sampling approach, and were interviewed and examined at age 32. Parental smoking during pregnancy (i.e. maternal, paternal and any parent) was primarily defined dichotomously (any number of cigarettes smoked daily by mother or father during pregnancy vs. non-smokers). Additionally, smoking was assessed by quantity of cigarettes smoked daily. Linear regression models were used to evaluate the associations of parental smoking during pregnancy with various offspring CMR factors, after controlling for potential confounders and for genetic variation in candidate genes.

Results

Prevalence of exposure to parental smoking in-utero (i.e. smoking of any parent) was 53.2% and 48.4% among the 17 years old and 32 years old samples, respectively. At age 17, smoking of at least one parent during pregnancy was significantly associated with weight (B = 1.39), height (B = 0.59), BMI (B = 0.32) and pulse rate (B = −0.78) (p-values < 0.001). At age 32, parental smoking, adjusted for covariates, was associated with 2.22 kg higher mean offspring weight, 0.95 cm higher mean offspring height, 0.57 kg/m² higher BMI, and 1.46 cm higher waist-circumference (p-values ≤ 0.02). Similar results, reflecting a dose response, were observed when maternal and paternal smokings were assessed by number of cigarettes smoked daily.

Conclusions

This prospective study demonstrates a potential long-term adverse effect of parental smoking during pregnancy on offspring health and calls for increasing efforts to promote smoking cessation of both parents before pregnancy.     

Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II

BACKGROUND: In older women and men, greater intakes of dietary calcium, potassium, and total fluid reduce the risk of kidney stone formation, while supplemental calcium, sodium, animal protein, and sucrose may increase the risk. Recently, phytate has been suggested to play a role in stone formation. To our knowledge, no prospective information on the role of dietary factors and risk of kidney stone formation is available in younger women. METHODS: We prospectively examined, during an 8-year period, the association between dietary factors and the risk of incident symptomatic kidney stones among 96 245 female participants in the Nurses' Health Study II; the participants were aged 27 to 44 years and had no history of kidney stones. Self-administered food frequency questionnaires were used to assess diet in 1991 and 1995. The main outcome measure was an incident symptomatic kidney stone. Cox proportional hazards regression models were used to adjust simultaneously for various risk factors. RESULTS: We documented 1223 incident symptomatic kidney stones during 685 973 person-years of follow-up. After adjusting for relevant risk factors, a higher dietary calcium intake was associated with a reduced risk of kidney stones (P =.007 for trend). The multivariate relative risk among women in the highest quintile of intake of dietary calcium compared with women in the lowest quintile was 0.73 (95% confidence interval, 0.59-0.90). Supplemental calcium intake was not associated with risk of stone formation. Phytate intake was associated with a reduced risk of stone formation. Compared with women in the lowest quintile of phytate intake, the relative risk for those in the highest quintile was 0.63 (95% confidence interval, 0.51-0.78). Other dietary factors showed the following relative risks (95% confidence intervals) among women in the highest quintile of intake compared with those in the lowest quintile: animal protein, 0.84 (0.68-1.04); fluid, 0.68 (0.56-0.83); and sucrose, 1.31 (1.07-1.60). The intakes of sodium, potassium, and magnesium were not independently associated with risk after adjusting for other dietary factors. CONCLUSIONS: A higher intake of dietary calcium decreases the risk of kidney stone formation in younger women, but supplemental calcium is not associated with risk. This study also suggests that some dietary risk factors may differ by age and sex. Finally, dietary phytate may be a new, important, and safe addition to our options for stone prevention.     

吸烟与男性早发冠心病的临床病因学的相关性研究

目的探讨吸烟与男性早发冠心病（PCAD）的关系。方法纳入270例经冠状动脉造影确诊为PCAD患者,其中男性组158例和女性组112例,对两组常见心血管危险因素（吸烟史、高血压、糖尿病、早发冠心病家族史、血脂异常等）进行分析。结果PCAD患者男性组和女性组平均年龄比较差异有统计学意义（P〈0．01）,男性组吸烟比例显著高于女性组,差异有统计学意义（P〈0．01）。两组间高血压、糖尿病、PCAD家族史无差异,但男性HDL-C（mg／d1）显著低于女性,差异有统计学意义（P〈0．01）。男性PCAD与吸烟呈正相关（OR=153．82,P〈0．01）,与HDL-C呈负相关（OR=0．95,P〈0．01）。结论男性PCAD的发病年龄早于女性,且与男性的吸烟和低HDL-C密切相关。     

Cigarette Smoking in Persons Living with Hepatitis C: The National Health and Nutrition Examination Survey (NHANES), 1999-2014

Background

Cigarette smoking is common in persons living with hepatitis C (hepatitis C+), but national statistics on this harmful practice are lacking. A better understanding of smoking behaviors in hepatitis C+ individuals may help in the development of targeted treatment strategies.

Naltrexone Decreases Heavy Drinking Rates in Smoking Cessation Treatment: An Exploratory Study

Background:  There is mixed support for the efficacy of the opioid antagonist naltrexone in the treatment of nicotine dependence. One potential unexplored mechanism underlying naltrexone's effects in smoking cessation may be in its ability to reduce alcohol consumption.
Methods:  Alcohol consumption and liver enzyme levels (aspartate aminotransferase and alanine transaminase) were examined in a sample of 78 nonalcoholic social drinking smokers (34 naltrexone, 44 placebo) enrolled in a double-blind randomized clinical trial of naltrexone in smoking cessation. Naltrexone or placebo began 3 days prior to the quit date (25 mg daily) and continued for 8 weeks (50 mg daily). All participants received nicotine patches and behavioral counseling up through 4 weeks after the quit date.
Results:  Naltrexone significantly reduced weekly heavy drinking rates. This effect was associated with greater nausea and pill taking adherence within the naltrexone group. Within heavy drinkers, naltrexone also directionally improved smoking quit rates compared with placebo. Liver enzyme levels did not differ during treatment with naltrexone compared with placebo.
Conclusions:  Naltrexone may reduce the frequency of heavy drinking in nonalcoholics attempting to quit smoking. Further, naltrexone may preferentially improve smoking quit rates within heavy drinkers who smoke, and further investigation in larger sample sizes is warranted.     

Smoking Prevalence and Cessation Characteristics among U.S. Adults With and Without COPD: Findings from the 2011 Behavioral Risk Factor Surveillance System

Introduction: Cigarette smoking is a major cause of chronic obstructive pulmonary disease, (COPD) but many persons with COPD continue to smoke. Quitting can help prevent the development of and complications from COPD. This study examined whether smoking and cessation behaviors differed among adults with a) COPD, b) asthma, c) other chronic conditions only, or d) no chronic conditions. Methods: Smoking and chronic disease status was obtained from 488,909 adults aged > 18 years using the Behavioral Risk Factor Surveillance System; 9,476 current smokers and recent quitters in 5 states responded to additional questions about cessation. We computed age-adjusted prevalence of smoking and past-year quit attempts, and used bivariate and multivariable logistic regression to identify correlates of past-year quit attempts. Results: Similar to the overall sample, in the 5-state sample, 47.3% of adults with COPD were current smokers versus 23.1% of those with asthma, 28.8% of adults with other chronic conditions, and 20.0% of those with no chronic conditions. Those with COPD did not differ significantly from those with asthma, other chronic diseases, or no chronic disease in having made a past-year quit attempt (59.7% versus 64.0%, 61.5%, and 53.9%, respectively). Smokers with COPD were significantly more likely than those with no chronic disease to have used cessation treatment resources, including a quitline, counseling, or medication (p < 0.001). Conclusions: Adults with COPD were just as likely as those without COPD to make a past-year quit attempt; however, approximately 40% of smokers with COPD did not try to quit.     

蒙古族居民吸烟、饮酒与高血压关系研究

目的 研究农牧区蒙古族居民吸烟、饮酒与高血压的关系。方法 于1997年6月－9月,采用标准化方法,对内蒙古通辽市部分农牧区3542名15岁及15岁以上蒙古族居民进行血压的和吸烟、饮酒等的调查,采用分层及标化方法进行统计分析。结果 吸烟－饮酒组的高血压标化患病率（26．2％）显著高于吸烟－不饮酒组（17．7％）。不吸烟－饮酒组的标化患病率（26．8％）显著高于不吸烟－不饮酒组（18．7％）。吸烟－饮酒组与不吸烟－饮酒组间标化患病率无显著差异。吸烟－不饮酒组与不吸烟－不饮酒组标化患病率也无显著差异。结论 饮酒是蒙古族居民高血压危险因素,而吸烟不是危险因素。     

Risk factors for prehypertension in the community: A prospective analysis from the Western New York Health Study

Background and AimPrehypertension is an increasingly highly prevalent condition in the general population, and is associated with an increased risk for coronary heart disease and stroke. However, evidence from population-based studies of the risk factors for prehypertension is scant. We sought to examine the predictors of progression from normotension to prehypertension in a community-based population from Western New York.Methods and ResultsA longitudinal analysis, over 6 years of follow-up, among 569 men and women (mean age 51.8 years) who were free of prehypertension, hypertension, cardiovascular disease and diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Incident prehypertension at follow-up was defined as systolic blood pressure of 120–139 mm Hg and/or diastolic blood pressure of 80–89 mm Hg.The cumulative six year incidence of prehypertension was 33.5% (189/564). In bivariate analyses, there were several correlates of incident prehypertension, including age, BMI and waist circumference, impaired fasting glucose (IFG), uric acid, and baseline blood pressure levels. After multivariate adjustment, IFG at baseline [odds ratio (OR): 1.70, 95% CI: 1.07–2.69) and weight gain since age 25 (OR: 1.12, 1.04–1.21 per 10 lb increase)] were the strongest significant predictors of prehypertension at follow-up. Neither baseline waist circumference nor change in BMI were predictor variables in models when they were substituted for weight gain.ConclusionsResults from this study suggest early dysregulation of glucose metabolism and weight gain over the lifespan may represent important risk factors for prehypertension in the general population.     

Effect of Cigarette Smoking on ACTH/Cortisol Secretion in Alcoholics After Short- and Medium-Term Abstinence

BACKGROUND: To gain a better insight into the alterations of the hypothalamic-pituitary-adrenal axis in alcoholism, we evaluated the ACTH response to nicotine inhaled from cigarette smoking (two nonfilter cigarettes in succession within 10 min) in nine nonalcoholic men and nine age- and weight-matched alcoholic men who had been addicted to alcohol for at least 8 years. All subjects were regular cigarette smokers. METHODS: Alcoholic men were tested after 2 weeks of abstinence, when the possible interferences because of alcohol assumption or the acute withdrawal period had completely ceased, and again after 12 weeks of abstinence. RESULTS: At both 2 and 12 weeks of abstinence, basal plasma ACTH and cortisol levels were not significantly different in the alcoholic men from those observed in the control group. In the control group subjects, cigarette smoking induced a striking increase in the circulating concentrations of ACTH and cortisol, with peak responses 1.4 and 1.5 times higher than baseline at 20 and 30 min, respectively. In contrast, no significant ACTH/cortisol increase was observed in alcoholic subjects at any time after cigarette smoking in any test. CONCLUSION: These data suggest that alterations of nicotinic cholinergic transmission occur in the control of ACTH secretion in the alcoholic men, providing further evidence of modification of the hypothalamic-pituitary-adrenal axis in alcoholism.     

Prospective study on alcohol intake and risk of subarachnoid hemorrhage among Japanese men and women

BACKGROUND: Few prospective data are available to evaluate potential risk factors of subarachnoid hemorrhage among the Japanese, although several prospective studies conducted in the United States and in Europe have shown a positive relationship between alcohol intake and the risk of subarachnoid hemorrhage. METHODS: A 9.4 year follow-up study was conducted on 12,372 men and women age 40 to 69 years who had no history of stroke, in six communities in Japan. The incident cases of subarachnoid hemorrhage were confirmed with computed tomography findings and/or clinical findings. Alcohol intake and other cerebrovascular risk factors were measured at the baseline examination. A Cox proportional hazard analysis was used to estimate the relative risks and 95% confidence intervals of the incidence of subarachnoid hemorrhage. RESULTS: During the follow-up assessment, 71 cases of subarachnoid hemorrhages occurred. For men, heavy drinking appeared to be an independent risk factor for subarachnoid hemorrhage; multivariate-adjusted relative risk was 4.3 (95% confidence interval [CI]: 1.1-16.8; p = 0.04). Among women, no excess risk was found for heavy drinking, probably due to the small number of heavy drinkers (n = 15). The combination of heavy drinking with smoking or hypertension increased the risk of subarachnoid hemorrhage substantially for men; the multivariate-adjusted relative risk was 6.0 (95% CI: 1.8-20.1;p = 0.004) for heavy drinking smokers and 13.0 (95% CI: 3.9-43.9; p < 0.001) for heavy drinking hypertensives. CONCLUSIONS: A reduction in alcohol intake, smoking cessation, and control of hypertension are important in preventing subarachnoid hemorrhage among Japanese men.     

高血压前期人群中心脑血管事件发生情况及影响因素

目的观察高血压前期人群中心脑血管事件发生情况及影响因素。方法采用前瞻性队列研究方法,以参加2006-07-2007-10健康查体的30～70岁开滦集团在职及离退休职工101510人中,符合美国预防、检测、评估与治疗高血压全国联合委员会第7次报告(JNC7)高血压前期诊断标准(30027人)和理想血压诊断标准(15614人)的人群作为观察队列。随访38.0～53.0(47.6±3.2)月,随访期间每半年收集1次新发心脑血管事件情况。观察高血压前期人群中心脑血管事件发生率并用多变量Cox比例风险回归模型分析影响心脑血管事件的因素。结果与理想血压人群相比高血压前期人群的平均年龄较大;男性比例较高;三酰甘油、总胆固醇、低密度脂蛋白胆固醇和体质量指数水平高(均P<0.05)。随访期间共发生461例心脑血管事件。高血压前期人群中总心脑血管事件、脑梗死、脑出血、心肌梗死和心脑血管病致死事件的累积发生率分别为1.19%、0.57%、0.20%、0.23%和0.23%,高于理想血压人群的0.67%、0.27%、0.12%、0.17%和0.15%,其中总心脑血管事件、脑梗死和脑出血累积发生率两组人群差异有统计学意义(均P<0.05)。校正其他传统心血管危险因素后,高血压前期人群发生总心脑血管事件和脑梗死的RR分别较理想血压人群增加37%(95%CI1.10～1.70)和56%(95%CI1.10～2.20)。结论高血压前期人群的总心脑血管事件、脑梗死和脑出血累积发生率高于理想血压人群;高血压前期是总心脑血管事件和脑梗死的独立危险因素。     

浙江省成年人主要死亡原因及其危险因素分析

目的调查我省成年人的主要死亡原因及其可以改变的危险因素。方法前瞻性队列研究。该队列包括年龄≥40岁的有代表性的男女性样本13267例,基线调查时间为1990年,于1999和2000年进行随访,随访率为99.0%。结果浙江省40~64岁人群中,恶性肿瘤、脑血管病、心脏病分别为:326.21/10万人.年、100.97/10万人.年、89.87/10万人.年。与未患高血压病者相比,高血压患者冠心病、脑卒中急性事件的发病相对危险度分别为:2.96、6.96;高血压患者的总死亡以及心脏病、脑卒中死亡的相对危险度分别为:2.4、2.6和6.9。结论肿瘤、心脑血管病是浙江省成人死亡的主要原因。控制高血压是降低心脑血管病发病率、死亡率和降低人群疾病死亡负担的重要策略。     

Airway obstruction in never smokers: results from the Third National Health and Nutrition Examination Survey

Purpose

Chronic obstructive pulmonary disease (COPD) is usually described as a disease of cigarette smoking. COPD is rarely considered in persons with no smoking history except in the context of another exposure. Accordingly, the disease has not been well characterized in these “never smokers.”

Methods

We evaluated airway obstruction (defined as forced expiratory volume in 1 second/forced vital capacity <0.70) in US adults aged 30 to 80 years interviewed in the Third National Health and Nutrition Examination Survey with valid spirometry who had never smoked. Previously described risk factors were examined for their association with obstruction in bivariate and multivariate analyses.

Results

Never smokers represented 42% of the Third National Health and Nutrition Examination Survey population aged 30 to 80 years, with obstruction prevalence of 91 per 1000. Never smokers accounted for 4.56 million cases of obstruction, or 23% of the total burden. Among these obstructed never smokers, 19% reported a prior diagnosis of asthma alone, and 12.5% reported COPD (alone or with asthma), leaving 68.5% with no prior respiratory diagnosis. After adjustment for other factors, higher rates of obstruction were significantly associated with increasing age, male sex, lower body mass index, and a history of allergies.

Conclusions

Never smokers represent a significant proportion of airway obstruction in US adults. Only one fifth of obstruction in this group is explained by asthma. COPD may explain much of the remainder, although known risk factors were not explanatory in this dataset. Recommendations that lung health screening programs be limited to smokers should be reconsidered.     

3059例卒中危险因素20年回顾性分析

目的分析卒中发生的常见危险因素，为卒中防治提供理论依据。方法对资料完整的3059例卒中患者的危险因素进行回顾性分析，探讨发生卒中的常见危险因素，如年龄、性别、高血压、糖尿病、冠心病、风湿性心脏病、卒中家族史以及吸烟、酗酒等不良习性，并进行双因素方差分析和X^2检验。结果3059例卒中患者中共有危险因素3286例次，依次为高血压1645例次、吸烟622例次、酗酒357例次、冠心病272例次、糖尿病191例次、风湿性心脏病105例次、卒中家族史94例次。结论高血压、吸烟与酗酒为卒中患者，尤其是老年男性的主要危险因素，加强对这些危险因素的干预，有助于卒中防治。     

Smoking and mortalities from cancer,coronary heart disease and stroke in male Japanese physicians

Summary A cohort of 5,477 male Japanese physicians was studied to examine the relationship between smoking habits and mortalities from cancer, coronary heart disease (CHD) and stroke over 12.7 years. The logistic regression analysis based on proportional hazard models was used for statistical assessment. The risks of both lung cancer and CHD were strongly associated with smoking habits in terms of the number of cigarettes smoked per day, inhalation level and age at starting to smoke. These associations were not influenced by the effect of drinking habits. However, the risk increment of lung cancer due to cigarette smoking was fairly small as compared with the data from other studies of male Caucasians. A statistically significant association was observed between upper aerodigestive cancer and cigarette smoking. But this relationship became insignificant after adjustment for drinking habits, and the risk of heavy smokers was drastically reduced. No clear association was noted between smoking and mortalites from gastric cancer and stroke.Partly supported by the Fukuoka-ken Anticancer Society