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Mortality Increased by 50% in Smokers with Diabetes

As many as one-fifth of patients with diabetes are smokers, despite clinical recommendations of smoking cessation. Prevalence of smoking in diabetic patients remains high as many patients continue to smoke after being diagnosed, therefore evaluating mortality and morbidity risks associated with smoking is important in diabetes management.

Researchers conducted a systematic review and meta-analysis of prospective cohorts to evaluate the relationship between active smoking with the risk of total mortality and cardiovascular events in patients with diabetes. Data included a total of 89 cohort studies. The pooled adjusted RR associated with smoking was 1.55 (1.46-1.64) for total mortality, and 1.49 (1.29-1.71) for cardiovascular mortality. The pooled RR was 1.44 (1.34-1.54) for total cardiovascular disease, 1.51 (1.41-1.62) for coronary heart disease, 1.54 (1.41-1.69) for stroke, 2.15 (1.62-2.85) for peripheral arterial disease, and 1.43 (1.19-1.72) for heart failure. Compared to never-smokers, former smokers were at a moderately elevated risk of total mortality (1.19; 1.11-1.28), cardiovascular mortality (1.15; 1.00-1.32), CVD (1.09; 1.05-1.13) and CHD (1.14; 1.00-1.30), but not for stroke (1.04; 0.87-1.23).

These results indicate that active smoking is associated with significantly increased risks of total mortality and cardiovascular events (by about 50%) in diabetic patients, while smoking cessation was associated with reduced risk compared to current smoking. Smoking cessation interventions should be a major focus for patients who smoke as it can reduce mortality and cardiovascular risk.

Practice Pearls:

  • The pooled adjusted RR associated with smoking was 1.55 (1.46-1.64) for total mortality, and 1.49 (1.29-1.71) for cardiovascular mortality.
  • The pooled RR was 1.44 (1.34-1.54) for total cardiovascular disease, 1.51 (1.41-1.62) for coronary heart disease, 1.54 (1.41-1.69) for stroke, 2.15 (1.62-2.85) for peripheral arterial disease, and 1.43 (1.19-1.72) for heart failure.
  • Active smoking is associated with significantly increased risks of total mortality and cardiovascular events (by about 50%) in diabetic patients, while smoking cessation was associated with reduced risk compared to current smoking. Smoking cessation interventions should be a major focus for patients who smoke as it can reduce mortality and cardiovascular risk.

Pan A, Wang Y, Talaei M, Hu FB. “Relation of Smoking with Total Mortality and Cardiovascular Events Among Patients with Diabetes: A Meta-Analysis and Systematic Review.” Circulation. 2015.