綜論吸菸與戒菸對糖尿病患者發生心臟血管疾病的影響

The Impact of Cigarette Smoking and Smoking Cessation on Cardiovascular Disease in Diabetic Patients

曾慶孝(Chin-Hsiao Tseng)

《中華公共衛生雜誌》 18卷4期 (1999/08) Pp. 241-246

https://doi.org/10.6288/CJPH1999-18-04-02

摘要

糖尿病是台灣地區的第五大死因，估計糖尿病病人的死亡有75%以上與動脈粥狀硬化有關，而吸菸又是心臟血管疾病的主要危險因子。估計美國每年所有冠狀動脈心臟病的死亡中，有30%可歸因於吸菸，而糖尿病病人的心臟血管疾病死亡中有65%可歸因於糖尿病與吸菸之交互作用。吸菸的糖尿病病人比未吸菸的糖尿病病人有較高的心臟血管疾病發生率、再發率、及死亡率，而戒菸可以很快地改善這些現象。有研究指出，發生心肌梗塞的病人戒菸一年後，可使心臟血管疾病的發生降低50%；在戒菸二年後羅志心臟血管疾病之危險性則與無吸菸者相當。美國Multiple Risk Factor Intervention Trial (MRFIT)的研究指出，在比較給予抗高血壓治療、降低膽固醇、給予阿斯匹靈、及實施戒菸等方式的介入時，戒菸的成效是最好的，而且糖尿病病人比無糖尿病者可由預防介入得到更大的效益。

關鍵字

吸菸 ； 戒菸 ； 心臟血管疾病 ； 糖尿病 ； 預防醫學

並列摘要

Diabetes mellitus is the fifth leading cause of death in Taiwan. More than 75% of causes of death in diabetic patients can be ascribed to atherosclerosis. Cigarette smoking has long been identified as an independent risk factor of cardiovascular disease. I n the USA, about 30% of cardiovascular mortality each year can be ascribed to cigarette smoking, and about 65% of cardiovascular mortality in diabetic patients can be ascribed to an interaction between diabetes mellitus and cigarette smoking. The incidence, recurrence rate, and mortality of cardiovascular disease in diabetic patients are all higher in smokers than in non-smokers. Smoking cessation can improve these phenomena. Patients alter myocardial infarction experienced a 50% reduction in cardiovascular events alter quitting smoking for 1 year. The risk was further reduced alter quitting for 2 two years to ale comparable to patients who did not smoke. Analysis of the theoretical benefits of four different approaches to reducing cardiovascular risk in diabetic and non-diabetic populations in the Multiple Risk Factor Intervention Trial (MRFIT) concluded that smoking cessation is the most effective intervention when compared to antihypertensive treatment, aspirin, and cholesterol lowering. Diabetic patients are prone to gain more beneficial effects than are non-diabetics from preventive interventions.

並列關鍵字

cigarette smoking ； smoking cessation ； cardiovascular disease ； mellitus ； preventive medicine