Wuhan, China —On February 1st, 2020, Prof. Gang Liu from School of Public Health, Huazhong University of Science and Technology, in collaboration with Prof. Qi Sun from Harvard University, published a paper, entitled ”Smoking cessation and weight change in relation to cardiovascular disease incidence and mortality in people with type 2 diabetes: a population-based cohort study”, in The Lancet Diabetes & Endocrinology（IF=24.54）. This study provided novel evidence that smoking cessation without subsequent weight gain was significantly associated with lower CVD and CHD incidence, as well as lower mortality, among smokers with diabetes. These data emphasize the importance of weight control upon smoking cessation to maximize the cardiovascular health benefits of quitting among smokers with diabetes.

Lifestyle modification plays a fundamental role in the prevention and management of diabetes. In particular, for diabetes patients who smoke, the risk of developing CVD and other morbidities is significantly boosted by both smoking and hyperglycemia. Therefore, smoking cessation is strongly advised for this group of patients. However, smoking cessation is often accompanied by weight gain, which is a potential health concern for diabetes patients because it might result in poor diabetes control and increased risk of developing diabetes complications. The knowledge base is limited regarding whether weight gain following smoking cessation attenuates the long-term reductions in the risk of primary diabetes complications associated with quitting, and previous studies generated inconsistent findings.

To address the limitations in previous studies and to further elucidate the role of weight gain in smoking cessation and CVD risk and mortality in diabetes patients, 10,809 men and women with diabetes who participated in the Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS) were included to investigate the relationship of smoking cessation and weight change with subsequent risk of total CVD, CHD, and stroke, and all-cause and cause-specific mortality. During 153,166 and 152,811 person-years of follow-up, 2,580 incident cases of CVD and 3,827 deaths occurred among participants with diabetes. Compared with those who continued to smoke, recent quitters (2-6 consecutive years since smoking cessation) without weight gain within the first 6 years of quitting had a significantly lower risk of CVD and CHD. The multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD were 0.83 (0.70-0.99) among all recent quitters, 0.77 (0.62-0.95) among recent quitters without weight gain, 0.99 (0.70-1.41) among recent quitters with weight gain of 0.1 to 5.0 kg, 0.89 (0.65-1.23) among recent quitters with weight gain of more than 5.0 kg, and 0.72 (0.61-0.84) among longer-term quitters (>6 consecutive years since smoking cessation). In addition, weight gain within 6 years following smoking cessation did not attenuate the inverse relationship between long-term quitting and mortality among diabetes patients. The multivariate-adjusted HRs (95% CIs) for mortality were 0.69 (0.58-0.82) among long-term quitters without weight gain within 6 years following cessation, 0.57 (0.45-0.71) among long-term quitters with weight gain of 0.1 to 5.0 kg, and 0.51 (0.42-0.62) among long-term quitters with weight gain of more than 5.0 kg. Similar results were observed for CVD and cancer mortality.

This study implies that smoking cessation without subsequent weight gain is significantly associated with a lower CVD incidence and mortality among smokers with diabetes. Weight gain following smoking cessation attenuates the reductions in the risk of developing CVD, but not premature death, among diabetic smokers who quit smoking. Therefore, to maximize the cardiovascular health benefits of smoking cessation, those with diabetes should control weight upon smoking cessation.

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