Smoke exposure in pipe and cigar smokers. Serum thiocyanate measures

Pipe or cigar smoking traditionally has been considered a less risky alternative to cigarette smoking. Some surveys and experimental studies have suggested, however, that former cigarette smokers who switch to cigars and/or pipe (CP) are more likely to inhale then CP users who never smoked cigarettes; but this relationship has not been consistently noted. To clarify smoke-exposure levels from CP smoking, smoking histories and serum thiocyanate (SCN) levels were studied in 9,106 adults aged 25 to 74 years in population-based surveys of seven upper Midwestern communities. Analyses of the 306 male CP smokers indicated a significantly higher SCN level in the ex-cigarette-smoking CP users vs the CP users who never smoked cigarettes. Serum thiocyanate levels of both CP groups were significantly higher than those of nonsmokers and lower than cigarette-only smokers. However, the number of pipe bowls or cigars smoked per day was also significantly related to SCN levels, and this could account for much of the association between SCN and previous cigarette smoking status. Individuals currently smoking four or more pipe bowls or four or more cigars per day had an elevated smoke exposure equivalent to about ten cigarettes per day, whether or not they previously smoked cigarettes. Because of these findings and because former cigarette smokers were more likely to report heavy CP usage, cigarette smokers should be advised to quit rather than to switch to a pipe or cigar.     

健康人群血浆纤维蛋白原与心血管危险因素的关系

目的:通过横断面研究来探明我国健康人群血浆纤维蛋白原(FIB)和其他心血管危险因素之间的相互关系.方法:筛查时入选500名健康受试者,询问生活习惯(吸烟、饮酒、体育锻炼);血浆FIB用Clauss法测定;血清C反应蛋白(CRP)用免疫比浊法测量;总胆固醇,高密度脂蛋白(HDL)用生化分析仪测量;最后进行统计学分析.结果:男性血浆FIB水平和年龄、吸烟、总胆固醇水平呈正相关关系;女性血浆FIB则只和年龄、总胆固醇成正相关.对整体研究对象而言,血浆FIB和HDL、运动状况呈负相关关系,而和体质量指数(BMI)、总胆固醇、CRP呈正相关.结论:有心血管危险因素的健康人群体内FIB水平升高,可以通过促进动脉粥样硬化和血栓形成使患心血管疾病的危险性升高.     

Elevation of blood viscosity, aggregation of red cells, haematocrit values and fibrinogen levels with cigarette smokers.

A study of blood viscosity factors was carried out on male smokers and non-smokers (125 volunteers) in the age group 45 to 55 years. The smoker's group exhibited elevated haematocrit values, fibrinogen levels and blood viscosity (P less than 0-025), and increased aggregation of red cells and plasma viscosity (P less than 0-005). Especially in the dependence of aggregation of red cells on the level of fibrinogen, the smokers of blood group O showed higher values than smokers of blood group A (P less than 0-01). Elevation of blood viscosity factors and functions in smokers suggests that pathways to ischaemia and thrombosis, to which smokers are more prone than non-smokers, may move through the blood high-viscosity syndromes.     

Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study

CONTEXT: Few studies have examined the interactive effects of smoking and serum cholesterol level on morbidity and mortality from cardiovascular dieseases. In East Asia, where the prevalence of smoking is among the highest in the world, morbidity and mortality from ischemic heart disease (IHD) is rapidly escalating. OBJECTIVES: To determine whether cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the Republic of Korea (South Korea), a population that has relatively low levels of serum cholesterol, and to determine whether serum cholesterol levels modify the risk relationship between smoking and ASCVD. DESIGN: Prospective cohort study with a follow-up period of 6 years (1993-1998). SETTING AND SUBJECTS: A total of 106745 Korean men aged 35 to 59 years who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1990 and 1992. MAIN OUTCOME MEASURES: Hospital admissions and deaths from IHD, cerebrovascular disease (CVD), and total ASCVD. RESULTS: At baseline, 61389 (58%) were current cigarette smokers and 64482 (60%) had a total cholesterol level of less than 5.17 mmol/L (200 mg/dL). Between 1993 and 1998, 1006 IHD events (176 per 100000 person-years), 1364 CVD events (238 per 100000 person-years), and 716 other ASCVD events (125 per 100000 person-years) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, and diabetes, current smoking increased the risk of IHD (risk ratio [RR], 2.2; 95% confidence interval [CI], 1.8-2.8), CVD (RR, 1.6; 95% CI, 1.4-1.8), and total ASCVD (RR, 1.6; 95% CI, 1.5-1.8). For each outcome, there were significant dose-response relationships with amount and duration of smoking. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of IHD and CVD. In the lowest quartile of serum cholesterol levels (<4.42 mmol/L [171 mg/dL]), the RR from current smoking was 3.3 (95% CI, 1.7-6.2) for IHD and 1.6 (95% CI, 1.2-2.3) for CVD. There was no evidence of an interaction between smoking and serum cholesterol (P for interaction = .75, .87, and .92 for IHD, CVD, and total ASCVD, respectively). CONCLUSIONS: This study demonstrates that in Korea smoking is a major independent risk factor for IHD, CVD, and ASCVD and that a low cholesterol level confers no protective benefit against smoking-related ASCVD.     

颈动脉粥样硬化的超声检查与其危险因素的关系研究

目的探讨用超声检测颈动脉内-中膜厚度的方法,分析颈动脉粥样硬化与其危险因素的关系。方法二维超声检查97例颈动脉粥样硬化患者和68例正常人颈动脉内-中膜厚度及斑块的大小,并对血清总胆固醇(TC)、载脂蛋白AI(apoAI)、apoB、纤维蛋白原(FIB)、C-反应蛋白(CRP)等水平在两组间比较。结果(1)颈动脉粥样硬化组血脂、FIB、CRP水平高于对照组;(2)FIB、CRP水平增高与颈动脉硬化患者斑块指数级别有明显关系;(3)Spearsm an相关分析显示CRP、FIB、LDL-C等水平升高与颈动脉粥样硬化呈显著正相关,多因素回归分析发现颈动脉粥样硬化与FIB、LDL-C等水平升高有关。结论CRP、脂质、FIB水平升高与颈动脉粥样硬化的严重程度有密切关系,颈动脉粥样硬化病变与多种脑血管病危险因素的聚集有显著相关性。     

Predictive value of serum uric acid on cardiovascular disease and all-cause mortality in urban Chinese patients

Background The association between increased serum uric acid （SUA） levels and cardiovascular risk has been debated for decades. Several large studies have provided conflicting results regarding the clinical significance of elevated SUA levels in cardiovascular disease （CVD） or cerebrovascular disease. The aim of this study was to investigate the relationship between SUA and CVD and all-cause mortality and their potential diagnostic value. Methods A total of 3570 in-patients ranging in age from 56 to 95 years （mean （67.36_＋11.36） years） were selected from 20 hospitals in Beijing and Shanghai. A carefully designed questionnaire was used to gather baseline data of each patient All patients were divided into two main groups according to their SUA levels： high SUA and normal SUA groups. Serum indices and other important parameters were measured. Results Compared with normal SUA group, high SUA group had significant difference in systolic blood pressure （SBP）, total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, body mass index （BMI）, and age （P 〈0.05 or P 〈0.01）. High SUA prevailed in female and patients with history of essential hypertension, while history of smoking and diabetes showed no significant difference between two groups. All-cause and CVD mortality occurred more frequently in high SUA group than in normal SUA group. In the accumulative survival analysis, high SUA group had lower survival rate than normal SUA group both in CVD and all-cause mortality. COX regression analysis indicated that the history of smoking, age and high SUA were independent risk factors for the development of CVD. Conclusions These preliminary observations suggest that patients with high SUA levels would face higher risk of mortality. SUA measurement may be applied as a routine predictor for clinical assessment.     

纤维蛋白原是冠心病的独立危险因素之一

目的研究纤维蛋白原（Fbg）等危险因素在冠心病（CHD）中的作用。方法对1017例CHD组和470例对照者组分别进行血浆Fbg浓度及其相关基因（（Hae Ⅲ多态性）测定分析。外周血白细胞抽提脱氧核糖核苷酸（DNA），采用酚／氯仿方法；多聚酶链反应（PCR）加酶切技术检测Fbg（Hae Ⅲ多态性。血浆Fbg浓度（200～400mg／dl）测定采用凝血酶法。血脂测定采用标准酶法。高血压病、糖尿病入选标准：①既往有明确高血压病、糖尿病病史者；②本次入院确诊者。每日吸烟1支以上超过1年定为吸烟者。所有数据采用SPSS11．0统计软件进行统计分析。结果（1）年龄、吸烟、高血压、糖尿病、血清胆固醇、三酰甘油和血浆Fbg水平是CHD危险因素；（2）Pearson相关分析显示年龄、高血压、糖尿病、血清胆固醇、高密度脂蛋白胆固醇、Fbg（Hae Ⅲ多态性和吸烟对血浆Fbg水平有明显影响。结论除已公认的CHD危险因素外，血浆Fbg浓度增高可能也是CHD的独立危险因素之一，并明显受其基因（HaeⅢ多态性和吸烟等诸多因素的影响。     

Prevalence of cardiovascular disease risk factors among attendees of the Batu 9, Cheras Health Centre, Selangor, Malaysia

This study describes the prevalence of selected cardiovascular disease (CVD) risk factors screened in patients 30 years and above attending a health centre in Cheras, Selangor. The study involved 3772 patients screened from March 2002 to June 2008. Risk factors screened included blood pressure, height, weight, serum total cholesterol, random blood sugar levels and smoking status. Majority of respondents were between 40 and 49 years of age (58.1%), males (64.7%) and ethnic Malays (74.4%). About two thirds (62.6%) were found to be overweight or obese, two fifths (40.2%) had hypercholesterolemia, a third (34.2%) had hypertension and 31.6% were smokers at some time. Overall 87% and 60% had at least one and two CVD risk factors respectively. Prevalence of four of the five risk factors screened was highest among the Malay middle aged men and lowest among the Chinese. Thus a substantial proportion of middle aged men were at high risk of CVD. Our findings show the need for ongoing monitoring of CVD risk factors and implementation of effective preventive strategies.     

Smoking prevalence and associated risk factors in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To describe the prevalence and patterns of smoking among Canadian adults, the relation of smoking to other cardiovascular disease risk factors and the awareness of the causes of heart disease. DESIGN: Population-based cross-sectional surveys. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 was selected from the health insurance registries in each province. Of these, 20,585 completed a questionnaire on smoking habits during a home interview. MAIN RESULTS: Approximately 29% of the Canadian population 18 years of age and over were regular cigarette smokers, and over 13% of regular smokers smoked more than 25 cigarettes per day. The proportion of women who had never smoked was higher (37%) than men (24%), except for young women aged 18 to 24. For all participants, there was a lower prevalence of high blood pressure and overweight among smokers than non-smokers. The prevalence of sedentary lifestyle, diabetes and elevated blood cholesterol was positively associated with smoking. The proportion of subjects who identified smoking as a cause of heart disease was higher among smokers, and over 90% believe that heart disease is preventable. CONCLUSION: Because smoking is positively associated with other cardiovascular risk factors, multifactorial and comprehensive approaches are needed in the implementation of cardiovascular disease prevention programs. Knowledge regarding the heart health hazards of smoking is high even among smokers. Motivational approaches that go beyond health risk messages are needed in cessation programs.     

吸烟者血清内皮抑素水平的临床意义

目的 探讨吸烟者血清血管内皮生长因子(vascular endothelial growth factor,VEGF)和内皮抑素(endostatin)水平的变化及其临床意义.方法 采用病例对照方法设计,对伴和不伴肺癌的164例吸烟者测定血清VEGF和endostatin水平,将20例不吸烟健康人作为正常对照组.结果 吸烟伴肺癌组(82例)血清VEGF水平明显高于吸烟无肺癌组(82例)及正常对照组(均P＜0.01);吸烟无肺癌组高于正常对照组(P＜0.05).吸烟伴肺癌组血清endostatin水平明显高于正常对照组(P＜0.01),但与吸烟无肺癌组比较差异无统计学意义(P＞0.05);吸烟无肺癌组高于正常对照组(P＜0.05).吸烟伴肺癌组血清endostatin/VEGF比值明显低于吸烟无肺癌组和正常对照组(均P＜0.01),但吸烟无肺癌组与正常对照组比较差异无统计学意义(P＞0.05).吸烟伴肺癌组和吸烟无肺癌组VEGF与endostatin均呈正相关(均P＜0.01).结论 吸烟可能导致endostatin/VEGF失衡而致癌.endostatin/VEGF比值可能是吸烟者早期诊断肺癌的指标之一,吸烟者应定期检测血清VEGF、endostatin水平及endostatin/VEGF比值.     

Effect of age and cigarette smoking on carcinoembryonic antigen levels.

Serum carcinoembryonic antigen (CEA) levels were determined by the Hansen-Z-gel technique in 276 healthy volunteers, of whom 154 were smokers and 122 nonsmokers. The mean CEA level was significantly higher in smokers (2.7 ng/ml) than in nonsmokers (1.9 ng/ml) (P less than .001), and a significantly higher percentage of smokers had elevated CEA levels (P less than .05). In both groups, CEA levels were directly related to age. Seventy-six of the 154 smokers who entered the study ceased smoking. Their CEA levels were determined at one, three, and six months after cessation of smoking. Within three months after cessation, elevated CEA levels declined to within the range of nonsmokers and did not appear to be influenced by previous smoking habits. Both age and smoking history must be considered for accurate evaluation of CEA levels. A reappraisal of the diseases associated with elevated CEA levels that considers the influence of age and smoking may invalidate some of the correlations previously reported.     

吸烟对HDL-C正常者的胆固醇外流功能影响的研究

目的:通过对比吸烟和不吸烟者外周血中高密度脂蛋白(high-density lipoprotein,HDL)相关的巨噬细胞胆固醇外流功能,以明确吸烟对于胆固醇逆向转运过程的影响。方法:分别纳入42名高密度脂蛋白胆固醇正常的吸烟者和不吸烟者为研究对象,使用胆固醇外流荧光分析法,测量研究对象外周血血浆中的HDL对J774A.1巨噬细胞外流率的影响。结果:两组研究对象在一般情况、血脂谱和高敏C反应蛋白基本一致情况下,吸烟组巨噬细胞胆固醇外流率显著低于不吸烟组,差异具有统计学意义[(25.72±7.36)%vs.(29.53±7.97)%,P<0.05],提示吸烟可影响HDL相关的胆固醇外流功能。结论:吸烟者HDL相关的胆固醇外流率显著低于不吸烟者,表明吸烟者体内HDL的抗动脉粥样硬化功能受到明显削弱,提示戒烟在心血管疾病一级预防中的重要性。     

血清胆固醇和吸烟与精神分裂症自杀意念

目的 探讨男性精神分裂症患者中自杀意念和血清胆固醇水平及吸烟状况的关系。方法 196例精神分裂症患者分为自杀意念组和无自杀意念组，进行血清胆固醇水平的测定，并记录患者吸烟情况。结果 自杀意念组血清胆固醇水平明显低于无自杀意念组。吸烟患者中自杀意念发生率高。结论 低血清胆固醇水平和吸烟可增加精神分裂症患者自杀的危险。     

Lower leptin levels in young non-obese male smokers than non-smokers

Since the effect of smoking on plasma leptin has been divergent in clinical trials, which might have occurred due to selection of heterogeneous study populations, we investigated whether there is such an association in a group of healthy, non-obese, young male adults.

A total of 54 smokers (mean age: 21.18±1.62; body mass index (BMI): 19.60±0.85) and 26 non-smokers (mean age 21.69±3.0; BMI: 21.59±1.39) with similar daily physical activities and diet and without any documented disease were enrolled, and their plasma leptin levels were determined for the comparison between the two groups.

The mean BMI and plasma leptin of smokers were significantly lower than in non-smokers. Plasma leptin in the smokers group correlated inversely with BMI and the amount of daily smoking. Below BMI 20 kg/m² and between 20.0 and 20.9 kg/m² the plasma leptin levels in smokers were significantly lower when compared to non-smokers.

Plasma leptin is decreased in healthy, young non-obese male smokers independently of the amount of body fat. High amount of smoking is associated with lower serum leptin as well.     

吸烟与颈动脉斑块形成及其性质的相关性研究

目的探讨吸烟与中老年男性颈动脉斑块形成及其性质之间的关系。方法研究对象来自原卫生部脑卒中高危人群筛查和干预项目筛查出的脑卒中高危人群。在排除了既往有心脑血管疾病史、已戒烟、颈动脉超声结果为同时含有稳定与不稳定两种斑块及筛查资料不全的人群后,最终选取深圳市梅林一村等6个社区中自愿参加脑卒中筛查的736例40岁以上男性常住户籍居民为研究对象进行分析。结果在调整了年龄、高血压、糖尿病、肥胖、大量饮酒、三酰甘油升高、总胆固醇升高、低密度脂蛋白胆固醇升高及高密度脂蛋白胆固醇降低等混杂因素后,吸烟者与不吸烟者相比,颈动脉稳定斑块和不稳定斑块形成危险均显著增加（OR=1.746,95%CI 1.149~2.653,P=0.009和OR=2.308,95%CI 1.405~3.793,P=0.001）;在将不同吸烟总量分级分析后发现,随吸烟总量等级升高两种斑块形成危险均显著增加,其中颈动脉稳定斑块形成危险随等级升高分别是不吸烟组的1.7倍（P=0.051）、1.9倍（P=0.016）、3.5倍（P=0.001）,颈动脉不稳定斑块形成危险分别是不吸烟组的1.8倍（P=0.060）、2.5倍（P=0.005）、3.3倍（P=0.010）;吸烟对两种斑块的影响差异无统计学意义（P〉0.05）。结论深圳市中老年男性吸烟增加颈动脉斑块形成的危险,且随吸烟总量等级的增大,颈动脉斑块形成的危险随之增大,但不影响斑块的稳定性。     

3373名居民吸烟现况及影响因素调查

2008年11月至2009年9月，对沈阳市两个区3373名就业者进行吸烟问卷调查及肺功能检测，对可能为影响因素的11个变量采用logistic回归模型进行单因素及多因素分析，并对吸烟所致疾病的认知情况做X2检验。总吸烟率为50．7％（1710／3373），其中男性86．8％（1458／1680），女性14．9％（252／1693）。可能的影响因素排序为：饮酒史、T作环境及多种基础疾病；而女性、大学以上学历、超重及50岁以上为可能的保护因素。调查者中有2478人参与了吸烟导致疾病的认知调查，吸烟815人，不吸烟1663人，两者对于吸烟导致慢性阻塞性肺疾病、哮喘、胎儿畸形、恶性肿瘤、流产、婴幼儿生长受限、死胎及心肌梗死的认知差异有统计学意义。     

Prognostic importance of the white blood cell count for coronary, cancer, and all-cause mortality

The relationship of white blood cell count (WBC) to fatal and nonfatal coronary heart disease (CHD) incidence and all-cause and cancer mortality was assessed in a subset of participants in the Multiple Risk Factor Intervention Trial (MRFIT). For this group of 6,222 middle aged men, total WBC count was found to be strongly and significantly related to risk of CHD, independent of smoking status. Change in WBC count from baseline to the annual examination just prior to the CHD event was found to be a significant and independent predictor of CHD risk. For each decrease in WBC count of 1,000/cu mm the risk for CHD death decreased 14%, controlling for baseline WBC count and other CHD risk factors (smoking, cholesterol level, diastolic blood pressure). The WBC count was strongly related cross-sectionally to cigarette smoking and smoking status as indicated by serum thiocyanate concentration. Smokers on average had a WBC count of 7,750/cu mm compared with 6,080/cu mm for nonsmokers. The WBC count was also significantly associated with cancer death, independent of reported smoking and serum thiocyanate levels.     

Morbidity and mortality of acute myocardial infarction in and around Aligarh

A 6-year retrospective study of 341 cases of acute myocardial infarction admitted to JN Medical College Hospital, Aligarh in respect of the incidence, complications and mortality in relation to age, sex, religion, smoking habit occupation and risk factors was made. The incidence was found to be 9 per 1000 hospital admissions. Maximum number of cases was in the age group of 51-60 years and male to female ratio was 7:1. There was no significant difference in incidence and mortality between Hindus and Muslims of both sexes. Highest incidence was noted among sedentary workers and smokers. Hypercholesterolaemia was found in only 17.01% cases, the rest having normal serum cholesterol levels. Hypertension and diabetes mellitus were associated in 24.05% and 12.32% cases respectively. Cardiac complications were noted in 43.4% of patients, the commonest being cardiac failure. Overall in-hospital mortality was observed to be 11.41% of which 79.49% had cardiac complications. Diabetics had significantly (p less than 0.05) higher mortality rate (21.43%) as compared to non-diabetics. Smokers had higher mortality rate compared to non-smokers (p less than 0.01). Although those with hypertension and with hypercholesterolaemia had higher mortality, the results were not statistically significant. The average day of expiry after acute myocardial infarction was 3.82 days during hospital stay.     

Blood carboxyhaemoglobin, plasma thiocyanate, and cigarette consumption: implications for epidemiological studies in smokers

Carboxyhaemoglobin and plasma thiocyanate concentrations were found to be significantly correlated with self-reported daily cigarette consumption in 360 smokers (r = 0.416 and 0.412 respectively; p less than 0.001). The extent to which inhalation patterns affected the intake of cigarette smoke constituents was determined from the partial correlation between carboxyhaemoglobin and plasma thiocyanate concentrations after the number of cigarettes smoke per day had been allowed for (r = 0.48). Thus 23% of the variation in carboxyhaemoglobin and thiocyanate concentrations was accounted for by the was a cigarette was smoked and a further 21% by the number smoked a day. Furthermore, the relation between carboxyhaemoglobin or plasma thiocyanate and daily cigarette consumption was not linear but reached an asymptote at consumption rates above 25 cigarettes a day. These results suggest that by itself daily cigarette consumption will not identify those smokers most at risk and will also underestimate and dose-response relationship between smoking and selected diseases.     

Association between smoking, pancreatic insulin secretion and insulin resistance in Chinese subjects with or without glucose intolerance

Background  There are studies suggesting smoking may increase the risk of type 2 diabetes. Effects of smoking on insulin secretion and insulin resistance (IR) are, however, controversial.
Methods  This is a cross-sectional study. Since there were very few smokers among Hong Kong Chinese women, only men (n=1068) were analyzed in this report. Fasting and 2-hour plasma glucose and insulin were measured. Insulinogenic index as well as beta-cell function and IR based on homeostatic model assessment (HOMA) by computer model (HOMA Calculator v2.2) were calculated.
Results  Of the 1068 men, 147 had newly diagnosed diabetes, 131 newly diagnosed impaired glucose tolerance (IGT) and 790 were non-diabetic normal controls. Smokers had similar fasting and 2-hour insulin levels, insulinogenic index and HOMA derived beta-cell function as compared to non-smokers in the groups with diabetes, IGT or normal oral glucose tolerance test (OGTT). IR was also similar between smokers, ex-smokers and non-smokers in those with normal OGTT. In men with IGT or diabetes, after adjustment for age and body mass index, smokers were more insulin resistant as compared to non-smokers (IR, IGT: 1.59±1.07 vs 1.03±0.54, P<0.05; diabetes: 1.96±1.36 vs 1.06±0.45, P<0.01). With Logistic regression analysis, comparing smokers and non-smokers, IR was independently associated with smoking (odds ratio (95% CI), IGT: 2.23 (1.05, 4.71); diabetes: 3.92 (1.22, 12.58)). None of the other insulin parameters enter into the model among those with normal OGTT or comparing ex-smokers and non-smoker or smokers and ex-smokers.
Conclusions  In Chinese men, smoking did not show any direct association with insulin levels and pancreatic insulin secretion. Smoking men with IGT or diabetes appeared more insulin resistant than their non-smoking counterparts.