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Relation of Smoking With Total Mortality and Cardiovascular Events Among Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review
Open accessAbstract
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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“Various forms of tobacco exposure continue to contribute to excess cardiovascular and other causes of death in multiple parts of the world.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [184]
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2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.03.010 · Cited by 1,896
KDIGO 2020 Clinical practice guideline for diabetes management in chronic kidney disease
de Boer, I. H., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2020) · Kidney International · doi:10.1016/j.kint.2020.06.019 · Cited by 1,399
KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease
Rossing, P., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2022) · Kidney International · doi:10.1016/j.kint.2022.06.008 · Cited by 1,373
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.03.009 · Cited by 1,193
Metadata
- Authors
- Pan, A., Wang, Y., Talaei, M., & Hu, F. B.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Circulation
- Published
- 2015-11-10
- Volume
- 132
- Issue
- 19
- Pages
- 1795-1804
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- 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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