为什么吸烟容易得冠心病
我国每年有 260 万人死于心血管疾病。每 12 秒就有 1 人被心血管疾病夺去生命。【1】在各类心脏病中,冠心病的死亡人数远超其他心脏病,80%猝死为冠心病所致!知己知彼,首先让我们了解什么是冠心病。冠心病(CHD)是由于冠状动脉粥样硬化使血管阻塞导致心肌缺血缺氧而引起的心脏病(冠状动脉粥样硬化性心脏病)和冠状动脉功能性改变(痉挛)的总称,又称“缺血性心脏病”。临床上可分为原发性心脏骤停、心绞痛、心肌梗死、心力衰竭和心律失常等类型。CHD 是严重威胁人们健康并造成大量死亡的一种心身疾病。[2]
作为一个呼吸内科医生,在临床多年的经验,让我看到,很多冠心病患者都有吸烟的嗜好。两者之间有着什么样关系呢。让我们用数据说话,研究显示,吸烟者冠心病的发生风险约是不吸烟者的 1.6 倍。[3]吸烟者非致死性急性心梗的风险约是不吸烟者的 2.95 倍。[4]吸烟者心源性猝死的风险约是不吸烟者的 2.47 倍。[5]吸烟使男性冠心病患者的死亡风险增加 21%,使女性患者增加 41%。[6]吸烟使冠脉介入治疗后,患者的死亡风险增加 76%。[7]介入治疗后,吸烟患者支架内血栓形成的风险是不吸烟者的 2.55 倍。[8]介入治疗后,吸烟患者非致死性心肌梗死的发生率(4.76%)显著高于不吸烟者(0.37%)。[9]吸烟能够降低β受体阻滞剂、抗心律不齐药物、抗凝药物治疗的效果。[10]存在被动吸烟的不吸烟女性发生冠心病的风险是无被动吸烟者的 2.36 倍。[11]
吸烟在全世界多数国家被认为是导致冠心病的主要危险因素,这是因为烟草燃烧时释放的烟雾中含有 3800 多种已知的化学物质,其中包括一氧化碳、尼古丁等生物碱、胺类、腈类、醇类、酚类、烷类、醛类、重金属元素等,它们有多种生物学作用,对人体造成多种危害。与冠心病有关的化学物质有 10 余种,能激惹和加重冠心病发病的主要成分是尼古丁和一氧化碳。特别严重的是,吸烟能诱发冠状动脉痉挛,使冠状动脉中的血流减慢,血流量减少,血液的粘稠度增加,导致心肌缺氧,甚至引起心肌梗塞。
所以,对于冠心病的治疗仅仅关注降压、调脂、降糖等常规措施是不够的,戒烟同样重要,不容忽视!据数据统计,戒烟使冠心病的死亡风险降低 36%。[12]戒烟年数越长,急性心梗的发生风险越小。戒烟使冠心病患者获益更多,包括心梗后的死亡风险下降 46%,[13]冠脉旁路移植术后的心脏性死亡风险下降 75%。[14]吸烟引发冠心病并不是一时的,而是经过长时间的积累,才会慢慢使脂肪积聚、血管闭塞。所以冠心病也是可防可预的,想要预防或是缓解冠心病,最主要的就是管住嘴。为了降低冠心病的发病率,提高全民的身体素质,我们应该坚决戒烟,切莫“死灰复燃。”
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