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Smoking and tobacco
Research
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
  1. Juuso I Blomster1,
  2. Mark Woodward1,2,3,
  3. Sophia Zoungas1,4,
  4. Graham S Hillis1,
  5. Stephen Harrap5,
  6. Bruce Neal1,
  7. Neil Poulter6,
  8. Giuseppe Mancia7,
  9. John Chalmers1,
  10. Rachel Huxley1,8
  1. 1The George Institute for Global Health, Sydney, New South Wales, Australia
  2. 2Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK
  3. 3Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  5. 5University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
  6. 6Imperial College and St Mary's Hospital, London, UK
  7. 7University of Milan-Bicocca and Instituto Auxologico Italiano, Milan, Italy
  8. 8School of Public Health, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Dr Juuso Blomster; jmakinen{at}georgeinstitute.org.au

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 all-cause 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 some evidence of a greater hazard in women.

Trial registration number NCT00145925.

  • EPIDEMIOLOGY
  • PUBLIC HEALTH

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 non-commercially, 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/

https://doi.org/10.1136/bmjopen-2015-009668

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