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Smoking as a modifier of the systolic blood pressure-induced risk of cardiovascular events and mortality: a population-based prospective study of middle-aged men
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Department of Medicine, University Hospital, S-205 02 Malmö.
Department of Medicine, University Hospital, S-205 02 Malmö.
Department of Medicine, University Hospital, S-205 02 Malmö.
2002 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, no 9, p. 1759-1764Article in journal (Refereed) Published
Abstract [en]

Objective To examine to what degree smoking habits modulate the relationship between systolic blood pressure (SBP) and risk for cardiovascular morbidity (first event) and mortality in middle-aged men. Design and methods In all, 22 444 middle-aged men were recruited from a population-based screening study (mean attendance rate 71%). Risk factor intervention was offered to about 20% of participants. Subjects were followed in local and national registers for cardiovascular morbidity and mortality during more than 17 years of follow-up. Lifestyle variables were investigated at baseline, including smoking habits. Event rates were calculated in relation to quintiles (Q1-Q5) of baseline SBP in untreated subjects, subdivided into categories of smoking habits, but also for 915 previously known, treated hypertensive (tHT) patients at baseline. Results We found an increasing incidence of first cardiovascular event (CE) with increasing SBP levels, ranging from 63.5 CE/10 000 person-years (Q1) to 62.3, 70.5,82.3 and 115.1 CE/10 000 person-years (Q2-Q5). The corresponding figure in tHTs; was 153 CE/10 000 person-years. If further subdivided into smokers/ex-smokers/non-smokers, the relative risks (RR) of smokers were 1.9 [95% confidence interval (Cl): 1.5-2.4], 2.1 (1.8-2.5), 2.3 (1.8-2.9), 1.8 (1.5-2.1), and 1.7 (1.5-2.0) compared to present non-smokers, in relation to SBP (Q1-Q5). In tHTs; the RR was 1.4 (1.1-1.8). Cardiovascular mortality rates differed in relation to SBP and smoking habits, from 40.3 (present non-smokers) and 70.7 (smokers) deaths/10 000 person-years in Q1, to 54.2 and 134.0 deaths/10 000 person-years in Q5. In tHTs the corresponding figures were 81.6 and 149.4 deaths/10 000 person-years, respectively. No difference in risk was found for never-smokers compared to ex-smokers in relation to SBP. The risk in moderate/heavy smokers (> 10 cigarettes/day) compared to other smokers (less than or equal to 10 cigarettes/day) was significantly (P < 0.005) increased only in Q5. Conclusion Increasing systolic blood pressure levels in middle-aged men is associated with an increasing risk of future cardiovascular events and mortality, an association modified by smoking habits. Patients with treated hypertension in the 1970-1980s were also at an increased risk in spite of healthcare efforts. This calls for a more comprehensive multiple risk factor approach for the management and reduction of cardiovascular risk in these patients. (C) 2002 Lippincott Williams Wilkins.

Place, publisher, year, edition, pages
2002. Vol. 20, no 9, p. 1759-1764
Keywords [en]
hypertension, mortality, screening, smoking, systolic blood pressure
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-26693DOI: 10.1097/00004872-200209000-00019ISI: 000178314900019OAI: oai:DiVA.org:oru-26693DiVA, id: diva2:578292
Available from: 2012-12-18 Created: 2012-12-18 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Risk factors for cardiovascular events and incident hospital-treated diabetes in the population
Open this publication in new window or tab >>Risk factors for cardiovascular events and incident hospital-treated diabetes in the population
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Well-established risk factors for CVD include increasing age, male sex, sedentary lifestyle, obesity, smoking, diabetes, hypertension, dyslipidaemia and low socio-economic status. Traditional risk factors do, however, not fully explain cardiovascular risk in general. In this thesis we focused on two conventional risk factors (smoking, blood pressure), and two unconventional risk markers (adiponectin, an adipocyte derived protein; and sialic acid (SA), a marker of systemic inflammation) for prediction of CVD events.

Aims: In Paper I we examined to what degree smoking habits modify the risk of CVD in relation to systolic blood pressure levels in middle-aged men. In Paper II we investigated the predictive role of adiponectin for risk of CVD as well as the cross-sectional associations between adiponectin and markers of glucose metabolism, also in men. In Paper III we examined if increasing pulse pressure (PP) and increasing levels of SA both increase the risk of CVD and whether their effects act in synergism. In Paper IV the association of SA with risk of incident diabetes mellitus and related complications, resulting in hospitalization, was studied.

Subjects and Methods: Two large-scale, population-based, screening studies with long follow-up periods have been used. The Malmö Preventive Project (MPP) was used with 22,444 individuals in Paper I and a sub cohort of 3,885 individuals in Paper II. The Värmland Health Survey (VHS) was used in Papers III and IV with 37,843 and 87,035 individuals, respectively.

Results: CVD risk increases with increasing systolic blood pressure levels and this risk is almost doubled in smokers. Total adiponectin level is not associated with increased risk of future CVD but it is inversely associated with markers of glucose metabolism. PP and SA both contribute to risk of future CVD. Adjustment for mean arterial pressure reduces the risk induced by PP. Elevated SA contributes to increased risk of incident diabetes and related complications leading to hospitalization.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 79
Keywords
Adiponectin, blood pressure, cardiovascular risk, diabetes, inflammation, pulse pressure, sialic acid, smoking
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-24173 (URN)978-91-7668-905-9 (ISBN)
Public defence
2012-12-14, Hörsal P1, Prismahuset, Örebro universitet, Fakultetsgatan 1, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-07-30 Created: 2012-07-30 Last updated: 2017-10-17Bibliographically approved

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Khalili, Payam

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