Population Health and Accountable Care Organizations

Abstract

In Reply Dr Ji and colleagues suggest that other changes in behavior associated with smoking cessation, such as change in diet and decrease in alcohol consumption, might contribute to the decrease in cardiovascular disease we observed in our study. We agree that smokers might adopt a healthier lifestyle when they quit smoking.In the Comment section of our article, we cited this as one of the mechanisms for a decrease in cardiovascular disease associated with smoking cessation. However, the main objective of our study was not to explore potential mechanisms responsible for the decrease in cardiovascular risk when smokers quit smoking but to test the hypothesis that weight gain following smoking cessation does not attenuate the cardiovascular benefits of smoking cessation.We adjusted for potential confounding factors at baseline such as body mass index, lipid profile, blood pressure, and alcohol consumption. Except for weight change, which was one of the prespecified mediating factors explored in our analysis, we did not adjust for other potential mediating factors, such as change in alcohol consumption or diet.Ji and colleagues raise an interesting hypothesis that could be tested in a different study. In the meantime, we believe that the conclusion of our study is valid: smoking cessation is associated with a lower risk of cardiovascular events compared with continuing smoking, and the weight gain that might follow smoking cessation does not offset this benefit.