Does Quitting Smoking Help to Reduce Cardiovascular Risk in Type 2 Diabetes?

A recent study was published evaluating the effect of smoking cessation on cardiovascular disease incidence and mortality in type 2 diabetes.  This study analyzed the people with type 2 diabetes from the Nurses’ Health Study and the Health Professionals Follow-Up study.  They wanted to see the impact of the patient quitting smoking and cardiovascular outcomes.

Quick Summary of the Findings:

• Compared to current smokers:
  • Cardiovascular disease
    • Recent Quitters (2-6 consecutive years of smoking cessation)
      • 17% lower risk in all recent quitters (HR 0.83; 95%CI 0.70-0.99)
      • Without weight gain  – 23% lower risk  (HR 0.77; 95%CI 0.62-0.95)
      • If gaining 0.1-5.0 kg – No reduction in risk (HR 0.99; 95%CI 0.70-1.41)
    • Long-term quitters (> 6 consecutive years of smoking cessation)
      • 28% lower risk in long-term quitters (HR 0.72; 95%CI 0.61-0.84)
  • Cardiovascular mortality
    • 31% lower all-cause mortality in long-term quitters (> 6 years) compared to smokers
    • Benefits of smoking cessation on all-cause mortality occurred even if the patient gained weight in the first 2-6 years after smoking cessation

What does this Mean for Practice?

• Smoking significantly increases the cardiovascular disease risk and all-cause mortality in people with type 2 diabetes
• If a patient can quit smoking for 2-6 years and does not gain weight
  • They have a lower risk of cardiovascular disease
• If a patient quits for 2-6 years but gains weight
  • They don’t see the beneficial drop in cardiovascular disease risk
• Long-term quitters (> 6 years)
  • Have a lower risk of cardiovascular, cancer and all-cause mortality regardless of any weight gain after quitting
• Bottom Line – Smoking cessation can improve CV outcomes in patients with type 2 diabetes.  Minimizing weight gain when quitting (by counselling, using smoking cessation therapy and using therapies like GLP-1 RA’s or SGLT2i’s) can lead to a more positive effect on cardiovascular risk. 

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