Blomster JI, Woodward M, Zoungas S, Hillis GS, Harrap S, Neal B, Poulter N, Mancia G, Chalmers J, Huxley R, et al.
BMJ open. Date of publication 2016 Jan 8;volume 6(1):e009668.
1. BMJ Open. 2016 Jan 8;6(1):e009668. doi: 10.1136/bmjopen-2015-009668.
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.
Blomster JI(1), Woodward M(2), Zoungas S(3), Hillis GS(1), Harrap S(4), Neal
B(1), Poulter N(5), Mancia G(6), Chalmers J(1), Huxley R(7).
Author information:
(1)The George Institute for Global Health, Sydney, New South Wales, Australia.
(2)The George Institute for Global Health, Sydney, New South Wales, Australia
Nuffield Department of Population Health, The George Institute for Global Health,
University of Oxford, Oxford, UK Department of Epidemiology, Johns Hopkins
University, Baltimore, Maryland, USA.
(3)The George Institute for Global Health, Sydney, New South Wales, Australia
School of Public Health and Preventive Medicine, Monash University, Melbourne,
Victoria, Australia.
(4)University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria,
Australia.
(5)Imperial College and St Mary's Hospital, London, UK.
(6)University of Milan-Bicocca and Instituto Auxologico Italiano, Milan, Italy.
(7)The George Institute for Global Health, Sydney, New South Wales, Australia
School of Public Health, Curtin University, Perth, Western Australia, Australia.
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.
Published by the BMJ Publishing Group Limited. For permission to use (where not
already granted under a licence) please go to
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DOI: 10.1136/bmjopen-2015-009668
PMCID: PMC4716176
PMID: 26747037 [Indexed for MEDLINE]
