Weight Gain After Smoking Cessation and Effect on MI and Stroke

Study Questions:

What is the relationship between smoking cessation, post-cessation body mass index (BMI) change, and risk of myocardial infarction (MI) and stroke in men?

Methods:

A prospective cohort study using the Korean National Health Insurance Service (NHIS) data set collected from 2002 to 2013 was implemented. Based on the first (2002–2003) and second (2004–2005) NHIS health check-up periods, 108,242 men aged >40 years without previous diagnoses of MI or stroke were grouped into sustained smokers, quitters with BMI gain, quitters without BMI change, quitters with BMI loss, and nonsmokers. BMI change was defined as the difference of >1.0 kg/m2 between the two health check-up periods. The participants were followed-up from January 1, 2006 to December 31, 2013. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox proportional hazard models adjusted for sociodemographic, health status, and family health history.

Results:

Mean age was 52 (8) years and did not differ between sustained, quitters, and nonsmokers. The great majority had a <5% 5-year risk of a cardiovascular event. Compared to the sustained smokers, the risk of MI and stroke was significantly reduced in both quitters with BMI gain (HR, 0.33; 95% CI, 0.16–0.70 for MI and HR, 0.75; 95% CI, 0.57–1.00 for stroke) and without BMI change (HR, 0.55; 95% CI, 0.37–0.83 for MI and HR, 0.75; 95% CI, 0.62–0.92 for stroke), but no significant association was found in quitters with BMI loss (HR, 0.91; 95% CI, 0.43–1.91 for MI and HR, 0.86; 95% CI, 0.57–1.31 for stroke), respectively. Nonsmokers had a lower risk of MI (HR, 0.37; 95% CI, 0.32–0.43) and stroke (HR, 0.68; 95% CI, 0.64–0.73) compared to the sustained smokers.

Conclusions:

The authors concluded that post-cessation BMI change did not significantly modify the protective association of smoking cessation with MI and stroke.

Perspective:

Among the biologic benefits associated with smoking cessation that may reduce cardiovascular events includes decrease in blood pressure and heart rate; decrease in systemic inflammatory markers, fibrinogen, and platelet reactivity; and rise in high-density lipoprotein cholesterol. Not available from this observation study includes the possibility of increasing leisure time activity and a healthier diet. That those who lost weight following smoking cessation had no reduction in MI or stroke requires confirmation, and similar studies are needed in women and non-Asian populations.

Clinical Topics: Prevention

Keywords: Blood Pressure, Body Mass Index, Body Weight, Body Weight Changes, Fibrinogen, Heart Rate, Leisure Activities, Medical History Taking, Myocardial Infarction, National Health Programs, Primary Prevention, Risk, Smoking Cessation, Stroke, Weight Gain


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