吸烟与心血管疾病幻灯片.pptVIP

吸烟与心血管疾病 北京协和医院心内科 华佗烟の康中国总部 联合制作 中国每年死于二手烟的人数Annual mortality from SHS exposure in China 吸烟是国人心血管病的重要危险因素 高血压 1.6 亿 血脂异常 1.6 亿 糖尿病 0.2 亿 IFG 0.2 亿 肥胖 0.6 亿 超重 2.0 亿 吸烟 3.5 亿 被动吸烟 5.4 亿 吸烟加重动脉粥样硬化 吸烟使血栓生成增加 吸烟增加冠心病死亡风险 吸烟增加心源性猝死的风险 每日吸烟量与心肌梗死发病的量效关系 戒烟是冠心病强效干预措施 戒烟者与持续吸烟者相比，反复发生心脏骤停风险明显降低 戒烟使急性心梗风险降低 与吸烟者相比，冠状动脉介入治疗后戒烟者整体死亡风险明显下降 戒烟使CABG术后病死率减低 对戒烟的生存收益进行评估，戒烟5年，生存率提高3％，戒烟5年可提高10％，戒烟15年则可提高15％。 Key Point Current smokers have elevated levels of tissue factor TF , which may be one of the mechanisms by which smoking is associated with increased atherothrombotic complications. TF is highly expressed in atherosclerotic plaques and its presence has been related to plaque thrombogenicity. TF may be present in the blood as well, and plays a role in the propagation of thrombosis. Acute coronary syndromes are associated with atherosclerotic lesion disruption and thrombus formation. Smoking has been implicated in both atherosclerotic progression and atherothrombotic complications. The objective of this study was to evaluate whether the increased rate of atherothrombotic complications observed in current smokers, is mediated through increased circulating levels of TF. Levels of TF were assessed by adding factor X, factor VIIa, and calcium to plasma, and then quantifying the concentration of factor Xa FXa . Circulating TF was reported as changes in factor FXa per unit time pmol/L/min . Subjects who smoke ?10 cigarettes per day with a smoking history of ?10 years were evaluated before and 2 hours after smoking 2 cigarettes. Baseline levels of circulating TF were significantly increased 2 hours after smoking 2 cigarettes 217?72 pmol/L [before] and 283?106 pmol/L/min FXa [after]; P .003 . The authors concluded that smoking has significant modulatory effects on plasma levels of circulating TF. Reference Sambola A, Osende J, Hathcock J, et al. Role of risk factors in the modulation of tissue factor activity and blood thrombogenicity. Circulation. 2003;107:973-977. Ke