Dose-response Relationship Between Smoking And The Degree Of Coronary Artery Stenosis

Background Cardiovascular disease(CVD)deaths have declined in recent decades as a result of improved management of cardiovascular diseases and their risk factors,including major efforts to curb tobacco use.Nevertheless,the public health impact of smoking-related cardiovascular diseases remains a global issue.Smokers experience a number of physiological side effects that increase the risk of cardiovascular disease(CVD),including insulin resistance,elevated levels of catecholamines that lead to increased heart rate and blood pressure,and hypercholesterolemia.Epidemiological and clinical studies have shown that the dose-and time-dependent effects of smoking increase the risk of cardiovascular events.Objective To investigate the dose-response relationship between smoking dose,smoking duration,smoking index and the degree of coronary artery stenosis.Methods This was a retrospective study,605 male patients with coronary heart disease were diagnosed by coronary angiography in the first affiliated Hospital and the second affiliated Hospital of Xinxiang Medical College from January 2019 to June 2020,age(27-85 years old),smoking history,blood pressure,blood routine,fasting blood glucose,blood lipid,coronary angiography results were collected.Multivariate logistic regression analysis was used to explore the influencing factors of coronary artery stenosis,and multivariate models were established by adjusting confounding factors to further explore the relationship between smoking exposure variables and the degree of coronary artery stenosis.The doseresponse relationship between smoking dose,smoking duration,smoking index and the degree of coronary artery stenosis was studied by restrictive cubic spline analysis.Results The results of multivariate logistic regression analysis showed that smoking,age and history of diabetes were related to the degree of coronary artery stenosis(P=0.006,P=0.007,P=0.001).Among the severe coronary artery stenoses,both current and previous smoking were related to the degree of coronary artery stenosis(P=0.001,P=0.007).After adjusting the confounding factors,it still showed that current smoking and previous smoking were related to the degree of coronary artery stenosis: model 2(adjusted for age and diabetes history): P=0.000,P=0.022;model 3(on the basis of model 2,adjusted for family history,hypertension history,hyperlipidemia history,drinking history and BMI): P=0.000,P=0.014.In the smoking group,the dose-response relationship between smoking exposure variables and the degree of coronary artery stenosis was discussed,and the effects of confounding factors were adjusted.The results showed that there was a non-linear dose-response relationship between smoking dose,smoking duration,smoking index and the degree of coronary artery stenosis.The OR=1 was smoking 20 cigarettes a day,smoking duration for30 years and smoking index 600,respectively.Conclusions Smoking more than 20 cigarettes per day or/and smoking duration over 30 years or/and a smoking index greater than 600 were associated with an increased risk of worsening coronary artery disease in men.