Excess risk of mortality and cardiovascular events associated with smoking among patients with diabetes: Meta-analysis of observational prospective studies

Qin, Rui; Chen, Tao; Lou, Qingqing; Yu, Dahai

doi:10.1016/j.ijcard.2011.12.100

Cited by 103 publications

(82 citation statements)

References 62 publications

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“…Results were consistant with other studies that had explored gender differences in diabetic patients, in the risks associated with CVD and mortality attributable to smoking 24,125,126 . The finding that diabetic women who smoked had higher coronary and mortality risks was consistent with previous researches 24,76 . The reason for these higher risks, compared to men, is still unknown, although delays in diagnosis, or the sub-128 optimal clinical management of T2DM in women have been proferred as reasons.…”

Section: 1: Thesis Research Objectivessupporting

confidence: 92%

“…When gender specific effects of smoking were compared, there was some evidence to suggest a stronger coronary and mortality hazard in women, when compared with men. This is consistent with the findings from previous reviews of the gender specific impact of coronary risk in both diabetic patients and the general population 24,76 . The mechanisms which might account for the higher risk of CVD and death in women who smoke 131 observed that older patients with a history of stroke were at the highest risk of stroke.…”

supporting

confidence: 92%

“…Various research studies have shown that cigarette smoking is an important and self-regulating risk factor for coronary heart disease, stroke and peripheral vascular diseases in T2DM patients [21][22][23] . A recent systematic review and meta-analysis by Quin et al in diabetic patients reported that cigarette smoking is associated with a 48% increased mortality risk, 54% increased risk of coronary heart disease, 44% increased risk of stroke, and 52% increased risk of myocardial infarction 76 .…”

Section: 13: Bmi Glycaemic Control and Obesity Paradox In T2dmmentioning

confidence: 99%

“…increased risk of coronary heart disease, 44% increased risk of stroke, and 52% increased risk of myocardial infarction 76 . Studies have shown that cardiovascular mortality in T2DM patients without coronary heart disease (CHD) is same as that of those with CHD and without T2DM 77,78 .…”

Section: 11: Cardiovascular Disease Risks In T2dm Patientsmentioning

confidence: 99%

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Disease progression in newly diagnosed Type 2 Diabetes Mellitus patients: a statistical analysis using Clinical Practice Research Datalink (CPRD)

Thomas¹

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Type 2 Diabetes Mellitus is a serious disease with a long duration and considerable associated morbidity. It affects a significant proportion of populations around the world irrespective of economic status and its prevalence is increasing despite the efforts of clinicians, researchers, public health professionals and policy makers. Most epidemiologic research has focused on exploring the risk factors associated with this disease. However the present research aims to increase understanding of the progression of the disease from initial diagnosis to death. AimsThe aims of this thesis, from a clinical perspective, are to (a) evaluate the trajectory of blood pressure as the disease progresses from initial diagnosis to death in a large longitudinal database of newly diagnosed type 2 diabetes mellitus patients;, (b) within sub-cohorts based on body mass index at time of diagnosis, explore HbA1c trajectories from diagnosis to death, particularly the association with treatment intensity; (c) examine the 'obesity paradox'; and (d) investigate gender specific effects of smoking on the risks of cardiovascular diseases. In addition the thesis explores methodological issues arising with the use of large longitudinal datasets, in particular issues relating to missing data and the effectiveness of multiple imputation as a technique to correct for this. Methods and ResultsThe thesis has used a dataset of 84596 newly diagnosed type 2 diabetes mellitus patients diagnosed Generalised estimating equation models were used to explore the longitudinal trajectories. Cox regression models were used to evaluate the gender specific effects of smoking and the obesity paradox in relation to mortality risks. Separate models were created for patients with and without cardiovascular diseases prior to diagnosis of type 2 diabetes mellitus. All models were adjusted for the effects of other potential confounding factors. Elevated HbA1c trajectories were associated with use of intensive medication irrespective of body mass index at the time of diagnosis. Patients with normal body mass index at the time of diagnosis had increased mortality risk compared to obese patients confirming the obesity paradox in type 2 diabetes mellitus. Those who died during the study had an elevated trajectory of blood pressure compared to those who remained alive and this was statistically significant, but not clinically ii significant. Elevated mortality risks were observed in those with higher and lower levels of systolic blood pressure compared to those with normal (130-139 mmHg). Considering diastolic blood pressure of 80-84 mmHg as the reference level, diabetic patients with higher levels had significantly increased mortality risk. Women who smoked had a higher risk of cardiovascular diseases and mortality than men who smoked. ConclusionClinical management, which aims to maintain good control over glycemic and blood pressure levels in patients with newly diagnosed type 2 diabetes mellitus, is the most important approach to avoid or to delay potential compli...

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Section: 1: Thesis Research Objectivessupporting

confidence: 92%

supporting

confidence: 92%

Section: 13: Bmi Glycaemic Control and Obesity Paradox In T2dmmentioning

confidence: 99%

Section: 11: Cardiovascular Disease Risks In T2dm Patientsmentioning

confidence: 99%

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Disease progression in newly diagnosed Type 2 Diabetes Mellitus patients: a statistical analysis using Clinical Practice Research Datalink (CPRD)

Thomas¹

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“…O tabagismo e o etilismo foram encontrados em 13% e 9% dos pacientes, respectivamente. Em pessoas com diabetes, estudos demonstraram estreita relação entre o tabagismo e doença coronariana, sendo a sua interrupção um fator preponderante na redução do risco de eventos cardiovasculares 17 . O consumo excessivo de álcool por pessoas com diabetes aumenta o risco de hipoglicemia tardia6, além de prejudicar o controle ponderal e acelerar complicações relacionadas a doença 18 .…”

Section: Realizouunclassified

Análise de indicadores de saúde de pacientes com diabetes atendidos pelo Centro Hiperdia de Viçosa

et al. 2016

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A prevalência de diabetes mellitus está sendo considerada uma epidemia global, com 382 milhões de pessoas atualmente afetadas em todo o mundo e previsão de aumento para 592 milhões para o ano 2035. Atualmente, o Brasil é o quarto país no mundo em número de diabetes. O presente estudo teve como objetivo descrever as características epidemiológicas de indivíduos com diabetes mellitus atendidos no Centro Hiperdia da cidade de Viçosa-MG, considerando características sociodemográficos, fatores de risco modificáveis e não modificáveis. Trata-se de um estudo descritivo, quantitativo, documental e de corte transversal. Foram analisados 547 prontuários, sendo 218 inativos e 329 pacientes ativos. A análise dos pacientes ativos demonstrou que 51% do número total de pacientes apresentavam diabetes mellitus tipo 2 associada à hipertensão. Em relação aos pacientes ativos, 72% apresentavam baixa renda familiar, 74% apresentavam baixa escolaridade, 74%, 78% e 57% apresentavam hipertensão arterial, sobrepeso/obesidade, inatividade física, respectivamente. A presença de dois ou mais antecedentes familiares para doenças coronarianas e metabólicas foi encontrada em 79% dos pacientes. A análise da glicemia de jejum e pós-prandial demonstrou valores inadequados em mais de 50% dos pacientes ativos. Os pacientes com diabetes atendidos pelo Centro Hiperdia de Viçosa apresentaram tanto fatores de risco modificáveis quanto não modificáveis, sendo ambos complicadores para o controle do diabetes e de um bom estado de saúde. Palavras-chave: AbstractThe prevalence of diabetes mellitus is being considered a global epidemic, with 382 million people currently affected worldwide and increase forecast for 592 million for the year 2035. Currently, Brazil is the fourth country in the world in number of diabetes. This study aimed to describe the epidemiological characteristics of individuals with diabetes mellitus treated at Hiperdia Center of Viçosa-MG, considering socio demographic, modifiable risk factors and not modifiable. This is a descriptive study, quantitative, documentary and cross-sectional. 547 records were analyzed, 218 retirees and 329 active patients. The analysis of the active patients showed that 51% of the total number of patients had a higher prevalence of type 2 diabetes mellitus associated with hypertension. In relation to active patients, 72% had low family income, 74% had low education, 74%, 78 % and 57% had high prevalence of hypertension, overweight/obesity, physical inactivity, respectively. The presence of two or more family history of coronary and metabolic diseases was found in 79% of patients. The analysis of fasting and postprandial proved inadequate values by more than 50% of the active patients. Patients with diabetes attended by the Hiperdia Center of Viçosapresented in addition to the disease itself, modifiable and non-modifiable risk factors, both being complicating for diabetes control and a good health.

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Efficacy and Safety of Varenicline for Smoking Cessation in Patients With Type 2 Diabetes

et al. 2022

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IMPORTANCEEvidence of effective smoking cessation interventions in patients with diabetes is limited. The unique behavioral and metabolic characteristics of smokers with type 2 diabetes warrants a randomized clinical trial of the smoking cessation drug varenicline. OBJECTIVE To evaluate the efficacy and safety of varenicline in patients with type 2 diabetes with an intention to quit smoking. DESIGN, SETTING, AND PARTICIPANTS This multicenter, double-blind, placebo-controlled randomized clinical trial recruited patients from 6 outpatient clinics in 5 hospitals in Catania, Italy.Patients with type 2 diabetes, who were smoking at least 10 cigarettes a day, and who intended to quit smoking were screened for eligibility. Eligible patients were randomized to either varenicline or placebo treatment. The trial consisted of a 12-week treatment phase followed by a 40-week follow-up, nontreatment phase. Intention-to-treat data analysis was performed from December 2020 to April 2021. INTERVENTIONSVarenicline, 1 mg, twice daily or matched placebo administered for 12 weeks.Patients in both treatment groups also received smoking cessation counseling. MAIN OUTCOMES AND MEASURESThe primary efficacy end point of the study was the continuous abstinence rate (CAR) at weeks 9 to 24. Secondary efficacy end points were the CAR at weeks 9 to 12 and weeks 9 to 52 as well as 7-day point prevalence of abstinence at weeks 12, 24, and 52. RESULTSA total of 300 patients (mean [SD] age, 57.4 [0.8] years; 117 men [78.0%] in varenicline group and 119 men [79.3%] in placebo group) were randomized to receive varenicline (n = 150) or placebo (n = 150). The CAR at weeks 9 to 24 was significantly higher for the varenicline than placebo group (24.0% vs 6.0%; odds ratio [OR], 4.95; 95% CI, 2.29-10.70; P < .001). The CARs at weeks 9 to 12 (31.3% vs 7.3%; OR, 5.77; 95% CI, 2.85-11.66; P < .001) and weeks 9 to 52 (18.7% vs 5.3%; OR, 4.07; 95% CI, 1.79-9.27; P < .001) as well as the 7-day point prevalence of abstinence at weeks 12, 24, and 52 were also significantly higher for the varenicline vs placebo group. The most frequent adverse events occurring in the varenicline group compared with the placebo group were nausea (41 [27.3%] vs 17 [11.4%]), insomnia (29 [19.4%] vs 19 [12.7%]), abnormal dreams (19 [12.7%] vs 5 [3.4%]), anxiety (17 [11.4%] vs 11 [7.3%]), and irritability (14 [9.4%] vs 8 [5.4%]). Serious adverse events were infrequent in both groups and not treatment-related. (continued) Key Points Question Is varenicline efficacious and safe in achieving long-term abstinence in patients with type 2 diabetes who are willing to quit smoking? Findings In this randomized clinical trial involving 300 patients with type 2 diabetes who smoked, varenicline was efficacious at weeks 12, 24, and 52 of the trial compared with placebo. Nausea, insomnia, abnormal dreams, anxiety, and irritability were reported at higher frequency among patients in the varenicline vs placebo group. No treatment-related serious adverse events were noted. Meaning Findings of this ...

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Excess risk of mortality and cardiovascular events associated with smoking among patients with diabetes: Meta-analysis of observational prospective studies

Cited by 103 publications

References 62 publications

Disease progression in newly diagnosed Type 2 Diabetes Mellitus patients: a statistical analysis using Clinical Practice Research Datalink (CPRD)

Disease progression in newly diagnosed Type 2 Diabetes Mellitus patients: a statistical analysis using Clinical Practice Research Datalink (CPRD)

Análise de indicadores de saúde de pacientes com diabetes atendidos pelo Centro Hiperdia de Viçosa

Efficacy and Safety of Varenicline for Smoking Cessation in Patients With Type 2 Diabetes

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