The harms of smoking and benefits of smoking cessation in women compared with men with type 2 diabetes: an observational analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial
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Published version
Author(s)
Type
Journal Article
Abstract
Objectives: In general populations, the adverse effects
of smoking on coronary risk have been demonstrated to
be greater in women than in men; whether this is true
for individuals with diabetes is unclear.
Design: Cohort study.
Setting: 20 countries worldwide participating in the
ADVANCE (Action in Diabetes and Vascular Disease:
Preterax and Diamicron modified release Controlled
Evaluation) trial.
Participants: 11 140 patients with type 2 diabetes
aged ≥55 years and in cardiovascular risk at the time of
randomisation.
Primary and secondary outcome measures: Major
cardiovascular events (death from cardiovascular
disease, non-fatal stroke or non-fatal myocardial
infarction (MI)), all cardiovascular events (major
cardiovascular event or peripheral arterial disease or
transient ischaemic attack), and all-cause mortality.
Secondary outcome measures were major coronary
events (fatal and non-fatal MI), major cerebrovascular
events (fatal and non-fatal stroke), nephropathy (new or
worsening renal disease), and all cancer.
Results: At baseline, 6466 (56% women) participants
were never-smokers, 1550 (28% women) were daily
smokers and 3124 (21% women) were former smokers.
Median follow-up time was 5 years. In Cox regression
models after multiple adjustments, compared with never
smoking, daily smoking was associated with increased
risk of all primary and secondary outcomes with the
exception of major cerebrovascular disease. Only for
major coronary events was there any evidence of a
stronger effect in women than in men (ratio of the
adjusted HRs women:men; 1.64 (0.83 to 3.26) p=0.08).
For all other outcomes considered, the hazards of
smoking were similar in men and women. Quitting
smoking was associated with a 30% reduction in allcause
mortality (p=0.001) in both sexes.
Conclusions: In individuals with diabetes, the effects
of smoking on all major forms of cardiovascular disease
are equally as hazardous in women and men with the
possible exception of major coronary events where
there was
of smoking on coronary risk have been demonstrated to
be greater in women than in men; whether this is true
for individuals with diabetes is unclear.
Design: Cohort study.
Setting: 20 countries worldwide participating in the
ADVANCE (Action in Diabetes and Vascular Disease:
Preterax and Diamicron modified release Controlled
Evaluation) trial.
Participants: 11 140 patients with type 2 diabetes
aged ≥55 years and in cardiovascular risk at the time of
randomisation.
Primary and secondary outcome measures: Major
cardiovascular events (death from cardiovascular
disease, non-fatal stroke or non-fatal myocardial
infarction (MI)), all cardiovascular events (major
cardiovascular event or peripheral arterial disease or
transient ischaemic attack), and all-cause mortality.
Secondary outcome measures were major coronary
events (fatal and non-fatal MI), major cerebrovascular
events (fatal and non-fatal stroke), nephropathy (new or
worsening renal disease), and all cancer.
Results: At baseline, 6466 (56% women) participants
were never-smokers, 1550 (28% women) were daily
smokers and 3124 (21% women) were former smokers.
Median follow-up time was 5 years. In Cox regression
models after multiple adjustments, compared with never
smoking, daily smoking was associated with increased
risk of all primary and secondary outcomes with the
exception of major cerebrovascular disease. Only for
major coronary events was there any evidence of a
stronger effect in women than in men (ratio of the
adjusted HRs women:men; 1.64 (0.83 to 3.26) p=0.08).
For all other outcomes considered, the hazards of
smoking were similar in men and women. Quitting
smoking was associated with a 30% reduction in allcause
mortality (p=0.001) in both sexes.
Conclusions: In individuals with diabetes, the effects
of smoking on all major forms of cardiovascular disease
are equally as hazardous in women and men with the
possible exception of major coronary events where
there was
Date Issued
2016-01-08
Date Acceptance
2015-11-27
Citation
BMJ Open, 2016, 6 (1)
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
6
Issue
1
Copyright Statement
This is an Open Access article distributed in accordance with
the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,
which permits others to distribute, remix, adapt, build upon this work noncommercially,
and license their derivative works on different terms, provided
the original work is properly cited and the use is non-commercial. See: http://
creativecommons.org/licenses/by-nc/4.0/
the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,
which permits others to distribute, remix, adapt, build upon this work noncommercially,
and license their derivative works on different terms, provided
the original work is properly cited and the use is non-commercial. See: http://
creativecommons.org/licenses/by-nc/4.0/
License URL
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
National Institute for Health Research
Grant Number
RDC02 79560
n/a
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
CORONARY-HEART-DISEASE
CIGARETTE-SMOKING
RISK-FACTOR
PROSPECTIVE COHORT
EXCESS RISK
METAANALYSIS
MELLITUS
INDIVIDUALS
MORTALITY
OUTCOMES
Publication Status
Published
Article Number
e009668
Date Publish Online
2016-01-08