To the Editors:
Tobacco smoking is a major risk factor for cardiovascular disease. It has been found that 30–40% of patients stop smoking spontaneously after the occurrence of serious cardiovascular events1。Pulmonary embolism is a potential lethal cardiovascular event, in which smoking behaviour has not yet been documented. Since patients surviving the acute embolus face an increased risk of arterial thrombotic events,IE。心肌梗塞和中风2-4, propensity to quit smoking following pulmonary embolism is of particular interest.
我们的目标是确定肺栓塞发作对吸烟行为的影响。我们将吸烟者的比例和肺栓塞患者成功戒烟的百分比与基于人群对照的患者的百分比。
来自大型肺栓塞患者的大型随访项目的数据用于分析。2001年1月至2007年7月在莱顿大学医学中心(荷兰莱顿)之间经历过急性肺栓塞的所有患者都有资格。所有患者都被邀请在我们的诊所进行控制访问。收集了准确的吸烟史,包括在肺栓塞后的肺栓塞和吸烟行为时的吸烟状态。人口控制的吸烟统计数据来自荷兰的全国性吸烟习惯注册表。通过荷兰政府的要求不断进行研究,每周与200个随机选择的荷兰家庭联系以评估其吸烟行为5。为了进行分析,我们使用了从2001 - 2007年期间从年龄> 20岁的人口对照中得出的数据,因为肺栓塞患者年龄少于20岁(0.3%)的肺栓塞患者的比例有限。
在研究期间,共有675例患者被诊断出患有肺栓塞。在675例患者中,有225名(33%)在受到质疑之前死亡。此外,由于合并症,地理原因,由于精神病疾病或年龄<18岁或其他原因,其余450名(31%)的患者未给予随访的知情同意。诊断后,对311名研究患者进行了3.7±1.88年(最大范围1.1–6.3岁)。总共190(61%,95%的置信区间(CI)55-67)患者在肺栓塞时证实了吸烟史(活跃或以前),其中94(30%,95%CI 25-36)患者积极吸烟。在这94例患者中,有32名(35%,95%CI 25-45)在诊断后的第一年成功戒烟。总体而言,在诊断出肺栓塞后,只有两名(0.64%,95%CI 0.08-2.3)开始吸烟。戒烟者的百分比与肺栓塞队列中的年龄无关。
Analysis of the control group showed that of the 117,100 population controls randomly selected between 2001 and 2007, 71,614 (61%, 95% CI 60–61%) were current or former smokers and 34,177 (29%, 95% CI 28–30%) were active smokers. There were no significant differences between the fraction of (active) smokers between the patients at the time of the pulmonary embolism and the controls (odds ratio (OR) 1.05, 95% CI 0.82–1.34). According to the registry, 4–5% (maximum) of the smokers were able to successfully quit yearly. If 5% was assumed, successful smoking cessation occurred in 1,709 of the 34,177 active smokers, which is significantly lower compared with the patient cohort (p<0.001; OR 10.3, 95% CI 6.88–15.4).
Our data demonstrate that a pulmonary embolism is a signal to quit smoking in a significant proportion of patients (35%), even without a specific intervention. In addition, randomly selected controls proved to have comparable smoking habits but a significantly smaller proportion of them was able to quit smoking successfully.
Our study has limitations. We could only interview patients who survived the pulmonary embolism and were willing to return to our hospital for a follow-up visit. Also, we have not verified with additional testing whether both the pulmonary embolism patients and the population controls actually stopped smoking. Nevertheless, all data were assessed prospectively in a large cohort. Further studies should focus on the reasons for smoking cessation, the relationship between smoking (cessation) and the occurrence of arterial thrombotic events in the clinical course of pulmonary embolism, and measures to further increase the number of patients quitting smoking.
利益声明
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