Key result
Smoking cessation was associated with a lower risk of cardiovascular disease events among adults without diabetes (HR 0.47; 95% CI 0.23-0.94), unattenuated by subsequent weight gain.
Why the study?
Does smoking cessation reduce total CVD events in adults with and without diabetes, and is this benefit attenuated by subsequent weight gain?
Cohort (n=3,251)
Does smoking cessation reduce total CVD events in adults with and without diabetes, and is this benefit attenuated by subsequent weight gain?
Effect estimate: HR 0.47 (95% CI 0.23-0.94)
Absolute Event Rate: 3.2% vs 5.9%
Smoking cessation is associated with a significantly lower risk of cardiovascular events, and this benefit is not attenuated by the weight gain that often follows quitting.
May encourage cessation counseling in nondiabetics despite weight gain; leaves open effects in diabetes and causality.
IMPORTANCE: Smoking cessation reduces the risks of cardiovascular disease (CVD), but weight gain that follows quitting smoking may weaken the CVD benefit of quitting. OBJECTIVE: To test the hypothesis that weight gain following smoking cessation does not attenuate the benefits of smoking cessation among adults with and without diabetes. DESIGN, SETTING, AND PARTICIPANTS: Prospective community-based cohort study using data from the Framingham Offspring Study collected from 1984 through 2011. At each 4-year examination, self-reported smoking status was assessed and categorized as smoker, recent quitter (≤ 4 years), long-term quitter (>4 years), and nonsmoker. Pooled Cox proportional hazards models were used to estimate the association between quitting smoking and 6-year CVD events and to test whether 4-year change in weight following smoking cessation modified the association between smoking cessation and CVD events. MAIN OUTCOME MEASURE: Incidence over 6 years of total CVD events, comprising coronary heart disease, cerebrovascular events, peripheral artery disease, and congestive heart failure. RESULTS: After a mean follow-up of 25 (SD, 9.6) years, 631 CVD events occurred among 3251 participants. Median 4-year weight gain was greater for recent quitters without diabetes (2.7 kg [interquartile range {IQR}, -0.5 to 6.4]) and with diabetes (3.6 kg [IQR, -1.4 to 8.2]) than for long-term quitters (0.9 kg [IQR, -1.4 to 3.2] and 0.0 kg [IQR, -3.2 to 3.2], respectively, P < .001). Among participants without diabetes, age- and sex-adjusted incidence rate of CVD was 5.9 per 100 person-examinations (95% CI, 4.9-7.1) in smokers, 3.2 per 100 person-examinations (95% CI, 2.1-4.5) in recent quitters, 3.1 per 100 person-examinations (95% CI, 2.6-3.7) in long-term quitters, and 2.4 per 100 person-examinations (95% CI, 2.0-3.0) in nonsmokers. After adjustment for CVD risk factors, compared with smokers, recent quitters had a hazard ratio (HR) for CVD of 0.47 (95% CI, 0.23-0.94) and long-term quitters had an HR of 0.46 (95% CI, 0.34-0.63); these associations had only a minimal change after further adjustment for weight change. Among participants with diabetes, there were similar point estimates that did not reach statistical significance. CONCLUSIONS AND RELEVANCE: In this community-based cohort, smoking cessation was associated with a lower risk of CVD events among participants without diabetes, and weight gain that occurred following smoking cessation did not modify this association. This supports a net cardiovascular benefit of smoking cessation, despite subsequent weight gain.
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Clair et al. (2013) conducted a cohort in Adults with and without diabetes (n=3,251). Smoking cessation vs. Continued smoking was evaluated on Incidence over 6 years of total CVD events (coronary heart disease, cerebrovascular events, peripheral artery disease, and congestive heart failure) (HR 0.47, 95% CI 0.23-0.94). Smoking cessation was associated with a lower risk of cardiovascular disease events among adults without diabetes (HR 0.47; 95% CI 0.23-0.94), unattenuated by subsequent weight gain.
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