吸菸是一種致命的成癮性疾病，每年有超過800萬人死於吸菸。 <sup>90</sup> 在台灣，成年吸菸率已從2008年的21.9%（男性38.6%，女性4.8%）下降至2019年的13.1%（男性23.1%，女性2.9%）。 <sup>91</sup> 然而，吸菸仍在台灣造成大量生命損失，每年約有24,000人死於吸菸。 <sup>91</sup> 戒菸可以挽救生命，減輕醫療負擔，即使是60歲以上的老年吸菸者也能從中受益。 <sup>92</sup> 持續的醫學教育，包括對醫生和諮商師進行團體培訓，提升他們幫助人們戒菸的知識和技能，以及在各醫院之間開展戒菸服務競賽，已被證明能有效促進台灣高心血管風險吸菸者的戒菸。 <sup>93</sup> 近年來，電子煙已成為一種流行的戒菸方式。然而，關於電子煙是否優於非電子菸戒菸方法的大規模統合分析結果卻相互矛盾。 <sup>94,95</sup> 此外，越來越多的證據引發了人們對電子煙使用不良反應的嚴重擔憂，例如電子煙或電子煙產品相關性肺損傷（EVALI）以及與電子煙使用相關的血壓升高和動脈僵硬。 <sup>96-98</sup> 總之，目前尚無確切證據顯示電子煙是更安全的戒菸替代方案，也沒有足夠的證據證明其長期心血管安全性。
建議：建議戒菸以降低整體心血管風險。 （證據等級 I，證據等級 A）
Cigarette smoking Smoking is a lethal addictive disorder and more than 8 million people die from smoking every year.90 In Taiwan, the prevalence of smoking among adult people has been declining from 21.9% (male 38.6%, female, 4.8%) in 2008 down to 13.1% (male 23.1%, female 2.9%) in 2019.91However, smoking still caused a huge loss of life in Taiwan and about 24,000 people die from smoking every year.91 Smoking cessation saves life and reduces healthcare burden and the benefits are seen even in old smokers (60 years).92 Continued medical education with group training of doctors and counsellors regarding knowledge and skill to help people quitting smoking followed by smoking cessation service contest among hospitals has been proved effective to promote smoking cessation for high CV risk smokers in Taiwan.93 Electronic cigarettes (EC) have been emerging as a popular way to facilitate tobacco cessation in recent years. However, large-scale meta-analysis about whether EC is superior to non-EC methods for tobacco cessation showed conflicting results.94,95 In addition, growing evidence has raised critical concerns regarding the adverse effects of EC use, such as EC or vaping product-associated lung injury (EVALI) and increased blood pressure and arterial stiffness associated with EC use.96e98 Collectively, there is still no solid evidence supporting that EC is a safer alternative for tobacco cessation, neither is there sufficient evidence to claim its long-term CV safety.
Recommendation Cessation of cigarette smoking is recommended to reduce overall CV risk. (COR I, LOE A)
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