Modifying Heart Disease Risk Due to Smoking by Fish Intake
Modifying Heart Disease Risk Due to Smoking by Fish Intake
Table 1 shows updated information on cardiovascular disease risk factors and intakes of selected nutrients and foods according to smoking status, stratified by dietary intake of seafood/fish. The prevalence of current smoking was 41% for men, 4% for women, and 21% for all subjects. In both low and high seafood/fish eaters, compared with never smokers, former smokers were more likely to be hypertensive and diabetic and to consume more alcohol. Compared with never smokers, subjects across increasing strata of current smoking (light, moderate, and heavy) were on average 4–5 years younger and less likely to practice sports, to be hypertensive, and to use lipid-lowering drugs but were more likely to be diabetic and to consume more alcohol and total energy. Increasing number of cigarettes smoked per day was associated with less consumption of fatty acids, cholesterol, fruits, and vegetables. Seafood/fish intake decreased across the smoking strata in subjects with low seafood/fish intake, whereas it increased across the smoking strata in those with high seafood/fish intake.
During 878,163 person-years of follow-up, we documented 584 incident cases of CHD (428 men and 156 women). There were 101 (74 men and 27 women) fatal coronary events and 483 (354 men and 129 women) nonfatal coronary events, including 516 (376 men and 140 women) myocardial infarctions.
The multivariable-adjusted hazard ratio for total CHD risk in the highest quintiles of seafood/fish intake versus the lowest quintiles were 0.83 (95% confidence interval (CI): 0.61, 1.17; P-trend = 0.25) for all subjects, 1.28 (95% CI: 0.78, 1.79; P-trend = 0.42) for never smokers, 0.90 (95% CI: 0.69, 2.06; P-trend = 0.67) for former smokers, and 0.63 (95% CI: 0.39, 1.02; P-trend = 0.05) for current smokers. Among current smokers, the reduced risk of CHD observed in the highest quintiles of seafood/fish intake compared with the lowest quintiles was primarily observed for nonfatal coronary events (hazard ratio = 0.55, 95% CI: 0.36, 0.92), not for fatal coronary events (hazard ratio = 1.62, 95% CI: 0.59, 2.51) (not shown in tables).
Table 2 shows the multivariable hazard ratio for CHD risk according to smoking stratum in all subjects and in subjects with low and high seafood/fish intakes. A positive dose-response association between cigarette smoking and risk of CHD was evident in all subjects and in subjects with a low seafood/fish intake (less than the median of 86 g/day). On the other hand, among subjects with a high seafood/fish intake (median or more; ≥86 g/day), the association between smoking and risk of CHD was attenuated and modified in light and moderate smokers; hazard ratios were 1.13 (95% CI: 0.64, 1.99), 1.29 (95% CI: 0.95, 2.04), and 2.00 (95% CI: 1.18, 3.51) in light, moderate, and heavy smokers with a high seafood/fish intake, respectively, compared with never smokers with a high seafood/fish intake. Similar associations were found for myocardial infarction and nonfatal coronary events, while no difference between low and high seafood/fish consumers was found for risk of fatal coronary events.
Sex-specific analysis (Web Table 1) revealed no difference in the association between smoking status and risk of CHD in all men and women. Because of the small number of female smokers and the very small numbers of cases among light, moderate, and heavy female smokers, the attenuated risk of CHD in female smokers with a high seafood/fish intake was still observed, but the confidence intervals were widened.
The highest age-adjusted incidence rate for CHD (0.16 cases per 1,000 person-years) was observed in heavy smokers who consumed less seafood/fish; therefore, we used this group as our reference group in Figure 1 and Web Table 2, to evaluate risk in the other 9 combination groups of seafood/fish intake and smoking status. The risk of CHD was lower in subjects with a high seafood/fish intake across the different current smoking strata (light, moderate, and heavy) but did not reach the lower risk observed in never or former smokers. Compared with heavy smokers with a low seafood/fish intake, heavy smokers with a high seafood/fish intake had a 23% reduction in the risk of CHD. In addition, compared with that in heavy smokers, the reduced risk of CHD varied in light and moderate smokers according to their seafood/fish intake, with a significant reduction in light smokers with a high seafood/fish intake; the multivariable-adjusted hazard ratios for CHD were 0.74 (95% CI: 0.48, 1.15) and 0.85 (95% CI: 0.57, 1.26), respectively, in light and moderate smokers with low seafood/fish intake and 0.57 (95% CI: 0.32, 0.98) and 0.70 (95% CI: 0.48, 1.20), respectively, in those with high seafood/fish intake. Risk of CHD in subjects who had never smoked or had quit smoking was much lower but did not vary according to seafood/fish intake; the multivariable-adjusted hazard ratios for CHD were 0.32 (95% CI: 0.22, 0.48) and 0.39 (95% CI: 0.26, 0.59), respectively, in those with low seafood/fish intake and 0.32 (95% CI: 0.19, 0.55) and 0.44 (95% CI: 0.29, 0.69), respectively, in those with high seafood/fish intake. Similar associations were observed for myocardial infarction and nonfatal coronary events (Web Table 2).
(Enlarge Image)
Figure 1.
Hazard ratios (HRs) and 95% confidence intervals (CIs; T-shaped bars) for coronary heart disease (CHD) according to smoking status and seafood/fish intake, Japan Public Health Centre-based Prospective Study on Cancer and Cardiovascular Disease, 1995–2009. Dark columns, low seafood/fish intake (less than median; <86 g/day); white columns, high seafood/fish intake (median or more; ≥86 g/day). The y axis is set to a logarithmic scale. Results were adjusted for age; sex; alcohol consumption; body mass index; histories of hypertension and diabetes; use of medication for hypercholesterolemia; sports during leisure time; public health center; and dietary intake (in quintiles) of fruits, vegetables, saturated fat, monounsaturated fat, n-6 polyunsaturated fat, cholesterol, and total energy. Heavy smokers with a low seafood/fish intake had the highest age-adjusted incidence of CHD per 1,000 person-years and therefore were used as the reference group. Never and former smokers with low or high seafood/fish intakes had a significantly reduced risk of CHD (P < 0.0001), and light smokers with a high seafood/fish intake also had a reduced risk (P < 0.05). P for interaction = 0.06 (Wald test).
Results
Table 1 shows updated information on cardiovascular disease risk factors and intakes of selected nutrients and foods according to smoking status, stratified by dietary intake of seafood/fish. The prevalence of current smoking was 41% for men, 4% for women, and 21% for all subjects. In both low and high seafood/fish eaters, compared with never smokers, former smokers were more likely to be hypertensive and diabetic and to consume more alcohol. Compared with never smokers, subjects across increasing strata of current smoking (light, moderate, and heavy) were on average 4–5 years younger and less likely to practice sports, to be hypertensive, and to use lipid-lowering drugs but were more likely to be diabetic and to consume more alcohol and total energy. Increasing number of cigarettes smoked per day was associated with less consumption of fatty acids, cholesterol, fruits, and vegetables. Seafood/fish intake decreased across the smoking strata in subjects with low seafood/fish intake, whereas it increased across the smoking strata in those with high seafood/fish intake.
During 878,163 person-years of follow-up, we documented 584 incident cases of CHD (428 men and 156 women). There were 101 (74 men and 27 women) fatal coronary events and 483 (354 men and 129 women) nonfatal coronary events, including 516 (376 men and 140 women) myocardial infarctions.
The multivariable-adjusted hazard ratio for total CHD risk in the highest quintiles of seafood/fish intake versus the lowest quintiles were 0.83 (95% confidence interval (CI): 0.61, 1.17; P-trend = 0.25) for all subjects, 1.28 (95% CI: 0.78, 1.79; P-trend = 0.42) for never smokers, 0.90 (95% CI: 0.69, 2.06; P-trend = 0.67) for former smokers, and 0.63 (95% CI: 0.39, 1.02; P-trend = 0.05) for current smokers. Among current smokers, the reduced risk of CHD observed in the highest quintiles of seafood/fish intake compared with the lowest quintiles was primarily observed for nonfatal coronary events (hazard ratio = 0.55, 95% CI: 0.36, 0.92), not for fatal coronary events (hazard ratio = 1.62, 95% CI: 0.59, 2.51) (not shown in tables).
Table 2 shows the multivariable hazard ratio for CHD risk according to smoking stratum in all subjects and in subjects with low and high seafood/fish intakes. A positive dose-response association between cigarette smoking and risk of CHD was evident in all subjects and in subjects with a low seafood/fish intake (less than the median of 86 g/day). On the other hand, among subjects with a high seafood/fish intake (median or more; ≥86 g/day), the association between smoking and risk of CHD was attenuated and modified in light and moderate smokers; hazard ratios were 1.13 (95% CI: 0.64, 1.99), 1.29 (95% CI: 0.95, 2.04), and 2.00 (95% CI: 1.18, 3.51) in light, moderate, and heavy smokers with a high seafood/fish intake, respectively, compared with never smokers with a high seafood/fish intake. Similar associations were found for myocardial infarction and nonfatal coronary events, while no difference between low and high seafood/fish consumers was found for risk of fatal coronary events.
Sex-specific analysis (Web Table 1) revealed no difference in the association between smoking status and risk of CHD in all men and women. Because of the small number of female smokers and the very small numbers of cases among light, moderate, and heavy female smokers, the attenuated risk of CHD in female smokers with a high seafood/fish intake was still observed, but the confidence intervals were widened.
The highest age-adjusted incidence rate for CHD (0.16 cases per 1,000 person-years) was observed in heavy smokers who consumed less seafood/fish; therefore, we used this group as our reference group in Figure 1 and Web Table 2, to evaluate risk in the other 9 combination groups of seafood/fish intake and smoking status. The risk of CHD was lower in subjects with a high seafood/fish intake across the different current smoking strata (light, moderate, and heavy) but did not reach the lower risk observed in never or former smokers. Compared with heavy smokers with a low seafood/fish intake, heavy smokers with a high seafood/fish intake had a 23% reduction in the risk of CHD. In addition, compared with that in heavy smokers, the reduced risk of CHD varied in light and moderate smokers according to their seafood/fish intake, with a significant reduction in light smokers with a high seafood/fish intake; the multivariable-adjusted hazard ratios for CHD were 0.74 (95% CI: 0.48, 1.15) and 0.85 (95% CI: 0.57, 1.26), respectively, in light and moderate smokers with low seafood/fish intake and 0.57 (95% CI: 0.32, 0.98) and 0.70 (95% CI: 0.48, 1.20), respectively, in those with high seafood/fish intake. Risk of CHD in subjects who had never smoked or had quit smoking was much lower but did not vary according to seafood/fish intake; the multivariable-adjusted hazard ratios for CHD were 0.32 (95% CI: 0.22, 0.48) and 0.39 (95% CI: 0.26, 0.59), respectively, in those with low seafood/fish intake and 0.32 (95% CI: 0.19, 0.55) and 0.44 (95% CI: 0.29, 0.69), respectively, in those with high seafood/fish intake. Similar associations were observed for myocardial infarction and nonfatal coronary events (Web Table 2).
(Enlarge Image)
Figure 1.
Hazard ratios (HRs) and 95% confidence intervals (CIs; T-shaped bars) for coronary heart disease (CHD) according to smoking status and seafood/fish intake, Japan Public Health Centre-based Prospective Study on Cancer and Cardiovascular Disease, 1995–2009. Dark columns, low seafood/fish intake (less than median; <86 g/day); white columns, high seafood/fish intake (median or more; ≥86 g/day). The y axis is set to a logarithmic scale. Results were adjusted for age; sex; alcohol consumption; body mass index; histories of hypertension and diabetes; use of medication for hypercholesterolemia; sports during leisure time; public health center; and dietary intake (in quintiles) of fruits, vegetables, saturated fat, monounsaturated fat, n-6 polyunsaturated fat, cholesterol, and total energy. Heavy smokers with a low seafood/fish intake had the highest age-adjusted incidence of CHD per 1,000 person-years and therefore were used as the reference group. Never and former smokers with low or high seafood/fish intakes had a significantly reduced risk of CHD (P < 0.0001), and light smokers with a high seafood/fish intake also had a reduced risk (P < 0.05). P for interaction = 0.06 (Wald test).
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