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Smoking cessation and weight change in relation to cardiovascular disease incidence and mortality in people with type 2 diabetes: a population-based cohort study

Published on Jan 7, 2020in The Lancet Diabetes & Endocrinology24.54
· DOI :10.1016/S2213-8587(19)30413-9
Gang Liu18
Estimated H-index: 18
(HUST: Huazhong University of Science and Technology),
Yang Hu11
Estimated H-index: 11
(Harvard University)
+ 6 AuthorsQi Sun62
Estimated H-index: 62
(Harvard University)
Sources
Abstract
Summary Background To reduce their overall substantially increased risk of cardiovascular disease and premature mortality, smoking cessation is especially important for people with diabetes. However, the effect of weight change after quitting smoking on the long-term health consequences of smoking cessation is unclear. We aimed to examine smoking cessation and subsequent weight change in relation to incident cardiovascular disease events and mortality among adults with type 2 diabetes. Methods In this population-based cohort study, we analysed data from people with type 2 diabetes from two prospective cohorts in the USA: the Nurses' Health Study (1976–2014) and the Health Professionals Follow-Up Study (1986–2014). We included participants from both cohorts who either had prevalent type 2 diabetes or were diagnosed during the study, and who were either current smokers or never smokers without cardiovascular disease or cancer at diagnosis of diabetes. Information on demographics, newly diagnosed diseases, medical history, and lifestyle factors, including smoking status and weight change, was updated every 2 years through validated questionnaires. We assessed the incidence of cardiovascular disease and all-cause and cause-specific mortality among recent quitters (within 6 years of stopping) and long-term quitters (>6 years) associated with weight change within 6 years of smoking cessation among people with type 2 diabetes. We did a multivariable-adjusted Cox proportional hazard models to estimate hazard ratios (HRs) for the associations of smoking cessation and weight change on the outcomes. Findings Of 173 229 total cohort participants (121 700 from the Nurses' Health Study and 51 529 from the Health Professionals Follow-Up Study), 10 809 people with type 2 diabetes were included in the incident cardiovascular disease analysis and 9688 were included in the mortality analysis. 2580 incident cases of cardiovascular disease occurred during 153 166 person-years of follow-up, and 3827 deaths occurred during 152 811 person-years of follow-up. Recent quitters (2–6 consecutive years since smoking cessation) without weight gain within the first 6 years of quitting had a significantly lower risk of cardiovascular disease than people who continued to smoke (multivariable-adjusted HR 0·83 [95% CI 0·70–0·99] among all recent quitters, 0·77 [0·62–0·95] among recent quitters without weight gain, 0·99 [0·70–1·41] among recent quitters with weight gain of 0·1–5·0 kg, 0·89 [0·65–1·23] among recent quitters with weight gain of >5·0 kg, and 0·72 [0·61–0·84] among longer-term quitters [>6 consecutive years since smoking cessation]). Weight gain within 6 years after smoking cessation did not attenuate the inverse relation between long-term cessation and all-cause mortality (multivariable-adjusted HR 0·69 [95% CI 0·58–0·82] among long-term quitters without weight gain, 0·57 [0·45–0·71] among long-term quitters with weight gain of 0·1–5·0 kg, and 0·51 [0·42–0·62] among long-term quitters with weight gain of >5·0 kg), with similar results observed for cardiovascular disease and cancer mortality. Interpretation Smoking cessation without subsequent weight gain is associated with a reduced risk of cardiovascular disease and mortality among smokers with type 2 diabetes. Weight gain after smoking cessation attenuates the reduction in risk of developing cardiovascular disease, but does not attenuate the beneficial effect of smoking cessation with respect to mortality. These findings confirm the overall health benefits of quitting smoking among people with type 2 diabetes, but also emphasise the importance of weight management after smoking cessation to maximise its health benefits. Funding US National Institutes of Health.
  • References (31)
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References31
Newest
#1Meredith S. Duncan (Vandy: Vanderbilt University)H-Index: 7
#2Matthew S. Freiberg (VUMC: Vanderbilt University Medical Center)H-Index: 30
Last. Hilary A. Tindle (VUMC: Vanderbilt University Medical Center)H-Index: 29
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Importance The time course of cardiovascular disease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years. Objective To evaluate the association between years since quitting smoking and incident CVD. Design, Setting, and Participants Retrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination in 1954-1958; offspring cohort...
6 CitationsSource
#1Kyuwoong Kim (SNU: Seoul National University)H-Index: 9
#2Seulggie Choi (SNU: Seoul National University)H-Index: 5
Last. SangMinPark (SNU: Seoul National University)H-Index: 26
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Abstract Background Smoking cessation may help the current smokers to reduce cancer risk. However, weight gain following smoking cessation may attenuate the protective association of cessation with cancer. Patients and methods Our study included 1,278,794 men who were aged 20–39 years and underwent two consecutive health examinations by the National Health Insurance Service, without previous diagnosis of cancer. Participants were categorized into continual smokers, quitters with different degree...
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#1Paul C. Dinh (IU: Indiana University)H-Index: 2
#2Lauren A. Schrader (IU: Indiana University)
Last. Juhua Luo (IU: Indiana University)H-Index: 20
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Abstract The relationship between smoking cessation, concurrent weight gain, and stroke events is not yet understood. Thus, we examined the association between smoking cessation and subsequent stroke risk and whether the association was modified by concurrent weight gain. In 2017, we analyzed data from 109,498 postmenopausal US women enrolled in the Women's Health Initiative from 1993 to 1998. Women with a history of cancer or cardiovascular disease events were excluded. The median length of fol...
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#1Yang HuH-Index: 11
#2Geng ZongH-Index: 20
Last. Qi SunH-Index: 62
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Abstract Background Whether weight gain after smoking cessation attenuates the health benefits of quitting is unclear. Methods In three cohort studies involving men and women in the United States, ...
20 CitationsSource
#1Gang Liu (Harvard University)H-Index: 18
#2Yanping Li (Harvard University)H-Index: 48
Last. Qi SunH-Index: 62
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Abstract Background Evidence is limited regarding the impact of healthy lifestyle practices on the risk of subsequent cardiovascular events among patients with diabetes. Objectives The purpose of this study was to examine the associations of an overall healthy lifestyle, defined by eating a high-quality diet (top two-fifths of Alternative Healthy Eating Index), nonsmoking, engaging in moderate- to vigorous-intensity physical activity (≥150 min/week), and drinking alcohol in moderation (5 to 15 g...
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#1Kyuwoong Kim (SNU: Seoul National University)H-Index: 9
#2SangMinPark (SNU: Seoul National University)H-Index: 26
Last. Kiheon Lee (SNU: Seoul National University)H-Index: 3
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This study aimed to investigate the association between smoking cessation, post-cessation body mass index (BMI) change and risk of myocardial infarction (MI) and stroke in men.A prospective cohort study using the National Health Insurance Service (NHIS) data set collected from 2002 to 2013 was implemented. Based on the first (2002-03) and second (2004-05) NHIS health check-up periods, 108 242 men aged over 40 years without previous diagnoses of MI or stroke were grouped into sustained smokers, q...
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Nature Reviews Endocrinology 12, 299–308 (2016) On page 302 of the above article, VLDL in Figure 2 was incorrectly labelled as VDL. This has been corrected online.
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Theodore Friedman and colleagues discuss the metabolic effects of smoking cessation, focusing mainly on post-cessation weight gain. The authors highlight considerations for future smoking-cessation programs and therapies, which should be designed with an emphasis on reducing post-cessation weight gain.
34 CitationsSource
#1An Pan (HUST: Huazhong University of Science and Technology)H-Index: 54
#2Yeli Wang (NUS: National University of Singapore)H-Index: 8
Last. Frank B. Hu (Harvard University)H-Index: 205
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Background —Prevalence of smoking in diabetic patients remains high, and reliable quantification of the excess mortality and morbidity risks associated with smoking is important for diabetes management. We performed a systematic review and meta-analysis of prospective cohort studies to evaluate the relation of active smoking with risk of total mortality and cardiovascular events among diabetic patients. Methods and Results —We searched MEDLINE and EMBASE databases through May 2015, and multivari...
55 CitationsSource
#1Deborah Lycett (Coventry University)H-Index: 8
#2Linda Nichols (University of Birmingham)H-Index: 15
Last. Paul Aveyard (University of Oxford)H-Index: 47
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Summary Background Smoking increases the risk of developing type 2 diabetes. However, several population studies also show a higher risk in people 3–5 years after smoking cessation than in continuing smokers. After 10–12 years the risk equates to that of never-smokers. Small cohort studies suggest diabetes control deteriorates temporarily during the first year after quitting. We examined whether or not quitting smoking was associated with altered diabetes control in a population study, for how l...
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