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.
Cohort (n=3,251)
Effect estimate: HR 0.47 (95% CI 0.23-0.94)
Absolute Event Rate: 3.2% vs 5.9%
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.
Clair et al. (Wed,) 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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