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Cigarette smoking, systolic blood pressure, and cardiovascular diseases in the asia-pacific region

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Presented by:
Nakamura K, Barzi F, Lam TH, Huxley R, Feigin VL, Ueshima H, Woo J, Gu D, Ohkubo T, Lawes CMM, Suh I, Woodward M

Published in: Health & Medicine, Business
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  • 1.
    • “ Cigarette Smoking, Systolic Blood Pressure, and Cardiovascular Diseases in the Asia-Pacific Region. ”
    • Nakamura K, Barzi F, Lam TH, Huxley R, Feigin VL, Ueshima H, Woo J, Gu D, Ohkubo T, Lawes CMM, Suh I, Woodward M
    • for Asia Pacific Cohort Studies Collaboration .
    • Stroke (published on 2008 Mar 6)
  • 2. Background and Purpose
    • Smoking and increased levels of blood pressure (BP) substantially increase the risk of cardiovascular diseases (CVD).
    • If these two risk factors have a synergistic impact on cardiovascular events, lowering BP and quitting smoking will contribute more to reducing CVD than would be expected from ignoring their interaction.
  • 3. Methods
    • A total of 41 cohorts involving 563,144 participants (82% Asians; 35% female) were included in the analysis with a mean age of 47 years .
    • H azards ratios (HR s ) and 95% confidence intervals (CI s ) for an increase in systolic blood pressure ( SBP ) were estimated by smoking status (non-smokers and current smokers) , using Cox proportional hazards regression models .
  • 4. Results
    • There was a log-linear relationship between SBP and all subtypes of CVD.
    • The HRs relating SBP to both CHD and ischemic stroke were broadly similar irrespective of smoking status.
    • The HRs relating SBP to hemorrhagic stroke (intracerebral hemorrhage) were greater in current smokers than in non-smokers.
  • 5. 110 120 130 140 150 160 0.7 1.0 2.0 3.0 5.0 8.0 12.0 A. Coronary heart disease Hazard ratio 110 120 130 140 150 160 0.7 1.0 2.0 3.0 5.0 8.0 12.0 C. Hemorrhagic stroke 110 120 130 140 150 160 0.7 1.0 2.0 3.0 5.0 8.0 12.0 B. Ischemic stroke 110 120 130 140 150 160 0.7 1.0 2.0 3.0 5.0 8.0 12.0 D. Other strokes Hazard ratio Usual SBP (mmHg) Usual SBP (mmHg) Usual SBP (mmHg) Usual SBP (mmHg) Continuous line Non-smokers Dashed line Current smokers Stroke
  • 6. Continuous line Non-smokers Dashed line Current smokers Stroke HR (95%CI) associated with a 10 mmHg increase in SBP 1 1.2 1.5 2 2.5 Men Women Asia ANZ <65 years 65+ years Overall 0.12 0.16 0.97 0.53 0.97 0.26 0.14 p value for interaction CHD Men Women Asia ANZ <65 years 65+ years Overall 0.20 0.08 0.91 0.42 0.28 0.84 0.53 Ischemic stroke Men Women Asia ANZ <65 years 65+ years Overall 0.01 0.19 0.05 0.30 0.78 0.008 0.003 Hem. stroke
  • 7. Conclusions
    • Smoking exacerbated the impact of SBP on the risk of hemorrhagic stroke.
    • Although quitting smoking and lowering BP are both crucial for prevention of CVD, combining the two could be expected to have extra beneficial effect on preventing hemorrhagic stroke.

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