Cited by 343Smoking Behavior and CessationDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Health and Risk Factors

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Relation of Smoking With Total Mortality and Cardiovascular Events Among Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review

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Pan, An, Wang, Yeli, Talaei, Mohammad, Hu, Frank B.·2015·Circulation

DOI 10.1161/circulationaha.115.017926PMC PMC4643392

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Abstract

BACKGROUND: The prevalence of smoking in diabetic patients remains high, and reliable quantification of the excess mortality and morbidity risks associated with smoking is important for diabetes management. We performed a systematic review and meta-analysis of prospective cohort studies to evaluate the relation of active smoking with risk of total mortality and cardiovascular events among diabetic patients. METHODS AND RESULTS: We searched Medline and Embase databases through May 2015, and multivariate-adjusted relative risks were pooled by using random-effects models. A total of 89 cohort studies were included. The pooled adjusted relative risk (95% confidence interval) associated with smoking was 1.55 (1.46-1.64) for total mortality (48 studies with 1,132,700 participants and 109,966 deaths), and 1.49 (1.29-1.71) for cardiovascular mortality (13 studies with 37,550 participants and 3163 deaths). The pooled relative risk (95% confidence interval) was 1.44 (1.34-1.54) for total cardiovascular disease (16 studies), 1.51 (1.41-1.62) for coronary heart disease (21 studies), 1.54 (1.41-1.69) for stroke (15 studies), 2.15 (1.62-2.85) for peripheral arterial disease (3 studies), and 1.43 (1.19-1.72) for heart failure (4 studies). In comparison with 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), cardiovascular disease (1.09; 1.05-1.13), and coronary heart disease (1.14; 1.00-1.30), but not for stroke (1.04; 0.87-1.23). CONCLUSIONS: Active smoking is associated with significantly increased risks of total mortality and cardiovascular events among diabetic patients, whereas smoking cessation is associated with reduced risks in comparison with current smoking. The findings provide strong evidence for the recommendation of quitting smoking among diabetic patients.

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Authors: Pan, A., Wang, Y., Talaei, M., & Hu, F. B.
Affiliations: Brigham and Women's Hospital (US)
ORCID: Pan, An
Wang, Yeli
Talaei, Mohammad
Hu, Frank B.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2015-11-10
Volume: 132
Issue: 19
Pages: 1795-1804
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.115.017926
PMC: PMC4643392
OpenAlex: W2147708693
Cited by: 343
References: 100
Citations by year: 2026: 18 · 2025: 38 · 2024: 48 · 2023: 35 · 2022: 38 · 2021: 36 · 2020: 39 · 2019: 35 · 2018: 20 · 2017: 24 · 2016: 12
FWCI: 13.75
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: University of Washington
Istituto di Ricerche Farmacologiche Mario Negri - IRCCS
Universiteit Maastricht
Universidad Complutense de Madrid
Maastricht Universitair Medisch Centrum
National Taiwan University Hospital
Université de Lausanne
National Taiwan University
National Heart, Lung, and Blood Institute (HL-034594, R01HL034594)
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, DK058845)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords: smoking, diabetes mellitus, all-cause mortality, cardiovascular events, cardiovascular mortality, coronary artery disease, stroke, peripheral arterial disease, heart failure, smoking cessation, former smokers, cardiovascular risk
MeSH terms: Cardiovascular Diseases, Diabetes Mellitus, Humans, Mortality, Risk Factors, Smoking, Smoking Cessation

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Relation of Smoking With Total Mortality and Cardiovascular Events Among Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review

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