RESUMO
The use of antiretroviral therapy for people with HIV (PWH) has improved life expectancy. However, PWH now lose more life-years to tobacco use than to HIV infection. Unfortunately, PWH smoke at higher rates and have more difficulty maintaining abstinence than the general population, compounding their risk for chronic disease. In this Commentary, we describe a United States National Cancer Institute-led initiative to address the relative lack of research focused on developing, testing, and implementing smoking cessation interventions for PWH. This initiative supports seven clinical trials designed to systematically test and/or develop and test adaptations of evidence-based smoking cessation interventions for PWH (eg, combination of behavioral and pharmacological). We summarize each project, including setting/recruitment sites, inclusion/exclusion criteria, interventions being tested, and outcomes. This initiative provides critical opportunities for collaboration and data harmonization across projects. The knowledge gained will inform strategies to assist PWH to promote and maintain abstinence, and ensure that these efforts are adaptable and scalable, thereby addressing one of the major threats to the health of PWH. Reducing smoking behavior may be particularly important during the COVID-19 pandemic given that smokers who become infected with SARS-CoV-2 may be at risk for more severe disease. IMPLICATIONS: This Commentary describes a National Cancer Institute-led initiative to advance the science and practice of treating tobacco use among PWH, which is now responsible for more life years lost than HIV. We describe the scope of the problem, the objectives of the initiative, and a summary of the seven funded studies. Harmonization of data across projects will provide information related to treatment mediators and moderators that was not previously possible. Stakeholders interested in tobacco cessation, including researchers, clinicians and public health officials, should be aware of this initiative and the evidence-base it will generate to advance tobacco treatment among this high-risk population.
Assuntos
Infecções por HIV/complicações , Morbidade , Fumar/mortalidade , Uso de Tabaco/mortalidade , COVID-19 , Humanos , National Cancer Institute (U.S.) , Pandemias , Abandono do Hábito de Fumar , Produtos do Tabaco , Abandono do Uso de Tabaco , Estados UnidosRESUMO
BACKGROUND: The present study sought to analyze smoking prevalence and smoking-attributable mortality estimates produced by the 2017 Global Burden of Disease Study for Brazil, 26 states, and the Federal District. METHODS: Prevalence of current smokers from 1990 to 2017 by sex and age was estimated using spatiotemporal Gaussian process regression. Population-attributable fractions were calculated for different risk-outcome pairs to generate estimates of smoking-attributable mortality. A cohort analysis of smoking prevalence by birth-year cohort was performed to better understand temporal age patterns in smoking. Smoking-attributable mortality rates were described and analyzed by development at state levels, using the Socio-Demographic Index (SDI). Finally, a decomposition analysis was conducted to evaluate the contribution of different factors to the changes in the number of deaths attributable to smoking between 1990 and 2017. RESULTS: Between 1990 and 2017, prevalence of smoking in the population (≥ 20 years old) decreased from 35.3 to 11.3% in Brazil. This downward trend was seen for both sexes and in all states, with a marked reduction in exposure to this risk factor in younger cohorts. Smoking-attributable mortality rates decreased by 57.8% (95% UI - 61.2, - 54.1) between 1990 and 2017. Overall, larger reductions were observed in states with higher SDI (Pearson correlation 0.637; p < 0.01). In Brazil, smoking remains responsible for a considerable amount of deaths, especially due to cardiovascular diseases and neoplasms. CONCLUSIONS: Brazil has adopted a set of regulatory measures and implemented anti-tobacco policies that, along with improvements in socioeconomic conditions, have contributed to the results presented in the present study. Other regulatory measures need to be implemented to boost a reduction in smoking in order to reach the goals established in the scope of the 2030 United Nations Agenda for Sustainable Development.
Assuntos
Fumar/epidemiologia , Fumar/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Carga Global da Doença , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Características de Residência , Distribuição por Sexo , Fumar/efeitos adversos , Fumar/mortalidade , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCTION: Mineral and bone metabolism disorders in chronic kidney disease (CKD-MBD) constitute a syndrome defined by changes in calcium, phosphorus (P), vitamin D and parathormone, fibroblast growth factor 23 (FGF-23) and its specific cofactor, Klotho. CKD-MBD, as well as smoking, are associated with an increased risk of cardiovascular disease. However, it is not known whether or not smoking impacts the cardiovascular risk in CKD- MBD. OBJECTIVE: To analyze the relationship between smoking and CKD-MBD markers. METHODS: We evaluated 92 patients divided into: 1) Control Group: non-smokers without CKD; 2) CKD group in stages III and IV under conservative treatment (20 non-smokers and 17 smokers); 3) CKD group on dialysis (21 non-smokers and 19 smokers). Clinical, demographic, and biochemical markers were compared between the groups. RESULTS: FGF-23 and Klotho levels were not different between smokers and non-smokers. Patients in the CKD group on conservative treatment had higher serum P than non-smokers (p = 0.026) even after adjusted for renal function (p = 0.079), gender (p = 0.145) and age (p = 0.986). CONCLUSION: Smoking confers a higher cardiovascular risk to CKD patients under conservative treatment as it is associated with higher levels of P. Further studies are needed to confirm and better elucidate this finding.
Assuntos
Doenças Ósseas Metabólicas/sangue , Fósforo/sangue , Insuficiência Renal Crônica/sangue , Fumar/sangue , Adulto , Fatores Etários , Idoso , Doenças Cardiovasculares/etiologia , Tratamento Conservador , Estudos Transversais , Feminino , Ferritinas/sangue , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos/sangue , Glucuronidase/sangue , Humanos , Proteínas Klotho , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Diálise Renal , Insuficiência Renal Crônica/terapia , Fatores de Risco , Fumar/efeitos adversos , Fumar/mortalidade , Vitamina D/sangueAssuntos
Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dispneia/mortalidade , Dispneia/fisiopatologia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/sangue , Testes de Função Respiratória , Fatores de Risco , Fumar/mortalidade , Análise de Sobrevida , Exacerbação dos SintomasRESUMO
Background: Identifying risk factors for long-term mortality in patients with chronic obstructive pulmonary disease (COPD) could improve their clinical management. Aim: To examine the clinical variables associated to long-term mortality in a cohort of COPD patients. Patients and Methods: A clinical and respiratory functional assessment, chest computed tomography and clinical follow up for five years was carried out in 202 COPD patients aged 66 ± 9 years (59% males), active or former smokers of 10 or more pack-years. Results: Thirty four percent of patients were active smokers, consuming 46 ± 23 packs/year, 86% had comorbidities, especially chronic cardiovascular and metabolic diseases. Forty-six patients died in the five years follow-up (5-year mortality was therefore 22.8%). In the univariate analysis, the main risk factors associated to long-term mortality were an older age, male sex, dyspnea severity, severe exacerbation risk, chronic respiratory failure, magnitude of lung emphysema, airflow obstruction and lung hyperinflation, reduction of thigh muscle cross-sectional area and physical activity limitation. In the multivariate analysis, the three independent risk factors for long-term mortality were dyspnea severity, chronic hypoxemia and exercise limitation measured with the six minutes' walk test. Conclusions: Systematic clinical assessment allowed to identify the main risk factors associated with long-term mortality in patients with COPD, which could be used in planning preventive and management programs aimed at the high-risk population.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fumar/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Testes de Função Respiratória , Fumar/mortalidade , Análise de Sobrevida , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Seguimentos , Fatores Etários , Doença Pulmonar Obstrutiva Crônica/sangue , Dispneia/fisiopatologia , Dispneia/mortalidade , Teste de Esforço , Exacerbação dos SintomasRESUMO
BACKGROUND: In the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial, randomization of diabetic patients with stable ischemic heart disease to insulin provision (IP) therapy, as opposed to insulin sensitization (IS) therapy, resulted in biochemical evidence of impaired fibrinolysis but no increase in adverse clinical outcomes. We hypothesized that the prothrombotic effect of IP therapy in combination with the hypercoagulable state induced by active smoking would result in an increased risk of myocardial infarction (MI). METHODS AND RESULTS: We analyzed BARI 2D patients who were active smokers randomized to IP or IS therapy. The primary end point was fatal or nonfatal MI. PAI-1 (plasminogen activator inhibitor 1) activity was analyzed at 1, 3, and 5 years. Of 295 active smokers, MI occurred in 15.4% randomized to IP and in 6.8% randomized to IS over the 5.3 years (P=0.023). IP therapy was associated with a 3.2-fold increase in the hazard of MI compared with IS therapy (hazard ratio: 3.23; 95% confidence interval, 1.43-7.28; P=0.005). Baseline PAI-1 activity (19.0 versus 17.5 Au/mL, P=0.70) was similar in actively smoking patients randomized to IP or IS therapy. However, IP therapy resulted in significantly increased PAI-1 activity at 1 year (23.0 versus 16.0 Au/mL, P=0.001), 3 years (24.0 versus 18.0 Au/mL, P=0.049), and 5 years (29.0 versus 15.0 Au/mL, P=0.004) compared with IS therapy. CONCLUSIONS: Among diabetic patients with stable ischemic heart disease who were actively smoking, IP therapy was independently associated with a significantly increased hazard of MI. This finding may be explained by higher PAI-1 activity in active smokers treated with IP therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.
Assuntos
Angioplastia Coronária com Balão , Coagulação Sanguínea , Ponte de Artéria Coronária , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Infarto do Miocárdio/etiologia , Isquemia Miocárdica/terapia , Fumar/efeitos adversos , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Biomarcadores/sangue , Brasil , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Intervalo Livre de Doença , Europa (Continente) , Feminino , Fibrinólise , Humanos , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/complicações , Isquemia Miocárdica/mortalidade , América do Norte , Inibidor 1 de Ativador de Plasminogênio/sangue , Modelos de Riscos Proporcionais , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/sangue , Fumar/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION:: The global tobacco epidemic has taken pandemic proportions, with about 1.3 billion users and 6 million annual deaths. This study aimed to analyze the trends in mortality from chronic obstructive pulmonary disease (COPD) and lung, lips, oral cavity, pharynx, and esophagus cancer in Brazil between 1990 and 2015. METHODS:: The study was made possible through a partnership between the Metrics and Health Assessment Institute (IHME), University of Washington, Ministry of Health and the GBD Brazil technical group, using estimates from the Global Disease Charge 2015 study. RESULTS:: The mortality rates due to COPD fell; in 1990, it was 64.5/100,000 inhabitants and in 2015, 44.5, a decrease of 31%. For the various types of cancer related to smoking, the decrease was in a lower proportion than for COPD. For lung cancer, rates were 18.7/100,000 inhabitants in 1990 to 18.3 in 2015. For women, there is an upward curve for lung cancer from 1990 to 2015, with an increase of 20.7%. DISCUSSION:: The study points to smoking as a risk factor for premature mortality and disability due to COPD and cancer. The significant reduction in tobacco prevalence in recent decades could explain reductions in tobacco-related disease trends. The higher mortality from lung cancer in women may express the delayed increase in smoking in this gender. CONCLUSION:: Nationwide actions taken in the last decades have had a great effect on reducing mortality from tobacco-related diseases, but there are still major challenges, especially when it comes to women and young people.
Assuntos
Fumar/efeitos adversos , Fumar/mortalidade , Tabagismo/complicações , Tabagismo/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/etiologia , Neoplasias/mortalidade , Fatores de Tempo , NicotianaRESUMO
Introduction The long-term risk of smoking in diabetic patients with stable ischemic heart disease (SIHD) is unknown. We sought to analyze the impact of smoking on outcomes of diabetic patients with SIHD when other cardiovascular risk factors are being aggressively treated. Methods The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial randomized 2368 diabetics with SIHD to intensive medical therapy (IMT) with prompt revascularization or IMT alone. Smoking status was obtained at baseline, 6 months, and 1, 2, 3, 4 and 5 years. The primary endpoint of interest was all-cause mortality. Results Of 2360 patients, 33.1% of patients never smoked, 54.4% were former smokers, and 12.5% were current smokers. The rate of all-cause mortality was greater for current (2.5 deaths/100 patient-years) and former smokers (3.1 deaths/100 patient-years) than never smokers (2.1 deaths/100 patient-years) (P = 0.007). Cardiac death, cardiovascular death, fatal or nonfatal myocardial infarction, and fatal or nonfatal stroke were not increased in current or former smokers compared with never smokers. Compared with never smokers, current smokers experienced a 49% increased hazard of death (Hazard Ratio (HR) 1.49, 95% Confidence Interval (CI): 0.97-2.29, P = 0.07) whereas former smokers had a 37% increased hazard of death (HR 1.37, 95% CI: 1.04-2.79, P = 0.02) when considering smoking status as a time-dependent variable and adjusting for factors that differed by smoking status. Conclusions Current and former smoking are associated with increased all-cause mortality in diabetics with SIHD but not with increased cardiovascular morbidity or mortality.
Assuntos
Ponte de Artéria Coronária , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Isquemia Miocárdica/terapia , Intervenção Coronária Percutânea , Comportamento de Redução do Risco , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Idoso , Brasil , Causas de Morte , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Europa (Continente) , Feminino , Humanos , Hipoglicemiantes/efeitos adversos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , América do Norte , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Modelos de Riscos Proporcionais , Fatores de Risco , Fumar/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
RESUMO: Introdução: A epidemia global do tabaco já assumiu proporções de pandemia, com cerca de 1,3 bilhão de usuários e 6 milhões de mortes anuais. Objetivo: Este trabalho teve como objetivo analisar as tendências de mortalidade por doença pulmonar obstrutiva crônica (DPOC) e câncer de pulmão, lábios, cavidade oral, faringe e esôfago, no Brasil, entre 1990 e 2015. Métodos: O estudo foi viabilizado mediante parceria entre o Instituto Métricas e Avaliação em Saúde (IHME), da Universidade de Washington, Ministério da Saúde e o grupo técnico GBD Brasil, utilizando análise de estimativas do estudo Carga Global de Doenças 2015. Resultados: As taxas de mortalidade por DPOC caíram, já que, em 1990, foi de 64,5/100.000 habitantes e, em 2015, 44,5, queda de 31%. Para os vários tipos de câncer relacionados ao tabaco, a queda foi em menor proporção do que a verificada para DPOC. A mortalidade por câncer de pulmão permaneceu estável, com taxa de 18,7/100.000 habitantes, em 1990, e 18,3/100.000 habitantes, em 2015. Entre as mulheres, observa-se curva ascendente, com aumento de 20,7%. Discussão: O estudo aponta o tabaco como fator de risco para mortalidade prematura e incapacidades por DPOC e câncer. A importante redução da prevalência do tabaco nas últimas décadas poderia explicar reduções nas tendências de doenças relacionadas com o tabaco. A maior mortalidade por câncer de pulmão em mulheres pode expressar o aumento tardio do tabagismo nesse sexo. Conclusão: Ações nacionais nas últimas décadas têm tido grande efeito na diminuição da mortalidade de doenças relacionadas ao tabaco, mas ainda há grandes desafios, principalmente quando se trata de mulheres e jovens.
ABSTRACT: Introduction: The global tobacco epidemic has taken pandemic proportions, with about 1.3 billion users and 6 million annual deaths. This study aimed to analyze the trends in mortality from chronic obstructive pulmonary disease (COPD) and lung, lips, oral cavity, pharynx, and esophagus cancer in Brazil between 1990 and 2015. Methods: The study was made possible through a partnership between the Metrics and Health Assessment Institute (IHME), University of Washington, Ministry of Health and the GBD Brazil technical group, using estimates from the Global Disease Charge 2015 study. Results: The mortality rates due to COPD fell; in 1990, it was 64.5/100,000 inhabitants and in 2015, 44.5, a decrease of 31%. For the various types of cancer related to smoking, the decrease was in a lower proportion than for COPD. For lung cancer, rates were 18.7/100,000 inhabitants in 1990 to 18.3 in 2015. For women, there is an upward curve for lung cancer from 1990 to 2015, with an increase of 20.7%. Discussion: The study points to smoking as a risk factor for premature mortality and disability due to COPD and cancer. The significant reduction in tobacco prevalence in recent decades could explain reductions in tobacco-related disease trends. The higher mortality from lung cancer in women may express the delayed increase in smoking in this gender. Conclusion: Nationwide actions taken in the last decades have had a great effect on reducing mortality from tobacco-related diseases, but there are still major challenges, especially when it comes to women and young people.