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美医学报告：禁烟可大幅降低心脏病发作风险 

（华盛顿综合讯）美国医学院发表报告指出，在公共场合以及工作场所禁止人们吸烟，大幅度减少烟客和非烟客心脏病发作的次数。

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Autoimmune condition, especially combined with smoking and oral contraceptive use, massively increases risk of stroke and heart attack in young women 

Autoimmune condition, especially combined with smoking and oral contraceptive use, massively increases risk of stroke and heart attack in young women

The autoimmune condition antiphospholipid syndrome mainly affects young women. An Article published Online First and in the November edition of the Lancet Neurology shows that women with a particular subtype of antibody called lupus anticoagulant (LA) have a more than 40-fold increased risk of stroke and 5-fold increased risk of heart attack compared with the general population (of young women). Smoking and oral contraceptive use increase the risk of these events even more. The Article is written by Dr Rolf Urbanus and Dr Philip de Groot, University Medical Centre Utrecht, Netherlands, together with colleagues from the Leiden University Medical Centre.

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Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study 

Interpretation

Our results suggest that lupus anticoagulant is a major risk factor for arterial thrombotic events in young women, and the presence of other cardiovascular risk factors increases the risk even further.

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• Autoimmune Condition, Especially Combined With Smoking And Oral Contraceptive Use, Massively Increases Risk Of Stroke And Heart Attack In Young Women 

The autoimmune condition antiphospholipid syndrome mainly affects young women. An Article published Online First and in the November edition of The Lancet Neurology shows that women with a particular subtype of antibody called lupus anticoagulant (LA) have a more than 40-fold increased risk of stroke and 5-fold increased risk of heart attack compared with the general population (of young women). Smoking and oral contraceptive use increase the risk of these events even more. The Article is written by Dr Rolf Urbanus and Dr Philip de Groot, University Medical Centre Utrecht, Netherlands, together with colleagues from the Leiden University Medical Centre.

Antiphospholipid syndrome occurs when autoantibodies* bind to cell membranes, interfering with the regular clotting mechanism of the blood. Diagnosis occurs when young women (under 50 years) suffer a thrombotic event such as a stroke or heart attack, and antiphospholipid antibodies are tested. Although it is known that this condition causes thrombosis, bleeding, and repeat miscarriage in women, the extent of the increased risk for stroke and heart attack was unknown before this study. . . .

In an accompanying Reflection and Reaction, Dr Kathryn Kirchoff-Torres and Dr Steven R Levine, Stroke Center, Mount Sinai School of Medicine, New York, NY, USA, say that the most important aspect of the study is its conclusion that young women with LA need to be warned about the dangers of smoking and use of oral contraceptives.

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Workplace Wellness Seems to Really Work 

Workplace wellness programs are an effective way to reduce major risk factors for heart disease, such as smoking, obesity, high blood pressure and diabetes, says a new American Heart Association policy statement.

Each year, heart disease costs the United States about $304.6 billion, the association says. Companies spend 25 to 30 percent of their annual medical costs on employees with significant health risks, mainly because of their increased likelihood of experiencing heart disease and stroke, it says.

But the financial burden also falls on workers, it says, in the form of higher premiums, co-pays and deductibles, reduction or elimination of coverage and trade-offs between insurance benefits and wage or salary increases. . . .

Keys to a successful program, according to the policy statement, include:

* Smoking/tobacco cessation and prevention

* Regular physical activity

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Opinion Former Briefing: Smoking ban reduces heart attacks  

The Royal College of Physicians commented:

"This is fantastic news - it shows that public policy measures can be really effective in changing people's behaviours and saving lives."

The Stroke Association commented:

“The long running campaign against smoking has saved thousands of lives and the latest research showing that the smoking ban is having such a big impact is a welcome sign that we can continue to reduce deaths and illness due to smoking. . . .

Diabetes UK commented: “we support the smoking ban and we are pleased to hear that it may reduce the number of heart attacks by more than a third in countries where it is implemented.

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• Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis  

In conclusion, in studies carried out in the United States and Sweden we detected an association between use of smokeless tobacco products and risk of fatal myocardial infarction and fatal stroke, which is not readily explained by chance. Confounding and other sources of bias, however, cannot be completely excluded on the basis of available data, although we found no strong evidence for their effect. If the association is real, its public health and clinical implications might be substantial, despite the fact that the magnitude of the excess risk is small. Future research should aim to clarify the mechanisms of effect of smokeless tobacco products on deaths from cardiovascular disease and to elucidate whether a similar effect is present for non-fatal myocardial infarction and non-fatal stroke.

What is already known on this topic Smokeless tobacco products are widely used in many populations An association with risk of cardiovascular disease is plausible

What this study adds This systematic review and meta-analysis provided evidence for an association between use of smokeless products and risk of fatal myocardial infarction and stroke . . .

CV Risk Seen With Smokeless Tobacco  

Action Points

* Explain to interested patients that smokeless products such as snuff and chewing tobacco may carry risks for fatal heart attacks and strokes.

* Explain that a study showed that the risks were small but the public health implications may be significant.

The use of smokeless tobacco products was associated with an increased risk for fatal myocardial infarction (MI) and stroke, a meta-analysis found.

For fatal MI, the relative risk associated with ever having used these products was 1.13 (95% CI 1.06 to 1.21), according to Paolo Boffetta, MD, and Kurt Straif, MD, PhD, of the International Agency for Research on Cancer in Lyon, France. . . .

Primary source: BMJ Source reference: Boffetta P, Straif K "Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis"

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Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis 

Design

Meta-analysis of observational studies from Sweden and the United States. . . .

Conclusion

An association was detected between use of smokeless tobacco products and risk of fatal myocardial infarction and stroke, which does not seem to be explained by chance.

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• Increased Risk Of Heart Attack And Stroke With The Use Of Smokeless Tobacco Products 

Research just published on bmj.com reports that people who use smokeless tobacco products like snus (a moist powder tobacco product) have a slightly higher risk of having a fatal heart attack or stroke.

Over the last couple of decades, there has been an increase in the number of people in Europe and North America using smokeless tobacco. Most new users are aged under 40. According to the study, since these products are being promoted as 'safer' alternatives to smoking cigarettes, the number of individuals using them is expected to increase.

Dr Paolo Boffetta at International Agency for Research on Cancer in France led the research team. They examined the results of 11 studies carried out in Sweden and North America on the use of smokeless tobacco products and the risk of developing or dying from a heart attack or stroke.

In order to reduce partiality, variations in study plan and features were considered.

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• Health research agencies form global alliance to curb humanity's most fatal diseases 

Six of the world's foremost health agencies, collectively managing an estimated 80% of all public health research funding, today announced formation of a landmark alliance to collaborate in the critical battle against chronic, non-communicable diseases: cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.

The health impact and socio-economic cost of these largely-preventable diseases is enormous and rising, potentially derailing efforts at poverty reduction.

The Global Alliance for Chronic Diseases (Alliance) is being created to support clear priorities for a coordinated research effort . . .

The Alliance's charter members are:

* Australia National Health and Medical Research Council;

* Canadian Institutes of Health Research;

* Chinese Academy of Medical Sciences;

* The U.K. Medical Research Council; and

* The U.S. National Institutes of Health, specifically its National Heart, Lung, and Blood Institute (NHLBI), and the Fogarty International Center. . . .

The following research priorities have been proposed by some founding Alliance members, for discussion at their inaugural scientific meetings in November:

* Test ways to prevent cardiovascular diseases and complications of diabetes;

* Identify and promote public health measures for controlling obesity;

* Characterize and quantify the major risk factors for chronic obstructive airways disease (both tobacco and environmental pollution) and the development of control measures; and

* Advance research into the problem of tobacco consumption and its relationship to cancer, cardiovascular disease and other disorders;

* Develop interventions to address the above priorities.

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Why Smoking Increases The Risk Of Heart Disease And Strokes 

Researchers at Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona have discovered a reason why smoking increases the risk of heart disease and strokes.

The study, which was presented at The Endocrine Society's 91st annual meeting in Washington, D.C., found that nicotine in cigarettes promotes insulin resistance, a pre-diabetic condition that raises blood sugar levels higher than normal. People with pre-diabetes are at greater risk of developing cardiovascular disease.

Theodore Friedman, MD, Ph.D., chief of the endocrinology division at Charles Drew University, said the findings help explain a "paradox" that links smoking to heart disease.

Smokers experience a high degree of cardiovascular deaths, Friedman said. "This is surprising considering both smoking and nicotine may cause weight loss and weight loss should protect against cardiovascular disease."

The researchers studied the effects of twice-daily injections of nicotine on 24 adult mice over two weeks. The nicotine-injected mice ate less food, lost weight and had less fat than control mice that received injections without nicotine.

"Our results in mice show that nicotine administration leads to both weight loss and decreased food intake," Friedman said. "Mice exposed to nicotine have less fat. In spite of this, mice have abnormal glucose tolerance and are insulin resistant (pre-diabetes)."

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• Effects of Timing and Extent of Smoking, Type of Cigarettes, and Concomitant Risk Factors on the Association Between Smoking and Subclinical Atherosclerosis  

The purpose of this study was to evaluate the effects of timing and extent of smoking, type of cigarettes, and concomitant vascular risk factors (VRFs) on the association between smoking and carotid intima-media thickness (C-IMT) in a lipid clinic population. . . .

Conclusions-- In the present cross-sectional observational investigation, carried out in a cohort of patients attending a lipid clinic, consumption of light cigarettes does not reduce the atherogenic effect of smoking on C-IMT. The number of pack-years, cigarettes/d, and years of smoking are relevant covariates in evaluating the effects of smoking on vascular health. The presence of diabetes or hypertension strengthens the association between smoking and cardiovascular risk.

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Minerva 

Smoking light cigarettes (with low nicotine, tar, or carbon monoxide content) did not seem to reduce the atherogenic effect of smoking on carotid intima-medial thickness in patients attending a lipid monitoring clinic. Thickness was highest in current smokers and lowest in never smokers, and it was positively related to the number of pack years in both former and current smokers. Diabetes and hypertension strengthened the association between smoking and cardiovascular risk (Stroke 2009;40:1991-8, doi:10.1161/strokeaha.108.543413).

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Lifestyle May Counter Blood Pressure Genes  

Being born with genes that predispose you to high blood pressure doesn't mean you're doomed to have it, a long-term study shows.

"It's been known for many years that blood pressure is affected by genes," said Dr. Nora Franceschini, an assistant professor of epidemiology at the University of North Carolina and lead author of a report on the study. "It's also known that lifestyle affects blood pressure. Now we are showing that they interact, and that the effect of those genes varies among individuals who have different behaviors."

It's an important finding because high blood pressure is a major risk factor for heart attack, stroke and other cardiovascular diseases. The study, reported online Tuesday in Circulation: Cardiovascular Genetics, "reinforces the message that lifestyle changes can alter the effect of genetics," Franceschini said.

That message comes from the Strong Heart Family Study, which has been looking at diabetes and high blood pressure among American Indians in Arizona, North and South Dakota and Oklahoma, an ethnic group in which the incidence of both is high. The study now includes more than 3,600 people aged 14 to 93.

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