Association of Smoking Cessation and Weight Change With Cardiovascular Disease Among Adults With and Without Diabetes

Study Questions:

Is smoking cessation associated with weight gain among adults with cardiovascular disease (CVD) and diabetes compared to CVD without diabetes?

Methods:

Data from the Framingham Offspring Study, a prospective community-based cohort, were used for the present analysis. The Framingham Offspring cohort began in 1971 and enrolled 5,124 children and spouses of children of the original Framingham Heart Study cohort. Participants of the Offspring cohort underwent repeated examinations approximately every 4 to 6 years. Data from 1984 through 2011 were included. Self-reported smoking status was assessed at each 4-year examination. Adults were categorized as smoker, recent quitter (defined as ≤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. The primary outcome of interest was incidence of total CVD events (including coronary heart disease, cerebrovascular events, peripheral artery disease, and congestive heart failure).

Results:

A total of 3,251 adult subjects, free of CVD at the beginning of examination 3 were included. Smoking prevalence decreased from 31% at the third examination to 13% at the eighth examination. Among participants without diabetes, recent quitters gained significantly more weight (median, 2.7 kg) than long-term quitters (0.9 kg), smokers (0.9 kg), and nonsmokers (1.4) (p < 0.001 for each pairwise comparison). Among participants with diabetes, recent quitters also gained significantly more weight (3.6 kg) than smokers (0.9 kg), long-term quitters (0.0 kg), and nonsmokers (0.5 kg) (p < 0.001 for each pairwise comparison). After a mean follow-up of 25 years, 631 CVD events occurred among 3,251 participants. Among participants without diabetes, age- and sex-adjusted incidence rate of CVD was 5.9 per 100 person-examinations (95% confidence interval [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:

The investigators concluded that 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.

Perspective:

Many adults gain weight after smoking cessation. Since weight gain can increase a patient’s risk for impaired glucose control and CVD, these findings provide the provider with clinically relevant information that the weight gain after smoking cessation does not significantly increase a patient’s risk for CVD.

Clinical Topics: Heart Failure and Cardiomyopathies, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Incidence, Follow-Up Studies, Cardiology, Heart Failure, Body Weight, Cardiovascular Diseases, Peripheral Arterial Disease, Risk Factors, Obesity, Weight Gain, Tobacco Use Disorder, Smoking Cessation


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