TY - JOUR AU - Zoungas S. AU - Huxley R. AU - Woodward Mark AU - Blomster J. AU - Poulter N. AU - Mancia G. AU - Harrap S. AU - Hillis G. AU - Chalmers J. AU - Neal Bruce AB -

OBJECTIVES: In general populations, the adverse effects of smoking on coronary risk have been demonstrated to be greater in women than in men; whether this is true for individuals with diabetes is unclear. DESIGN: Cohort study. SETTING: 20 countries worldwide participating in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial. PARTICIPANTS: 11 140 patients with type 2 diabetes aged >/=55 years and in cardiovascular risk at the time of randomisation. PRIMARY AND SECONDARY OUTCOME MEASURES: Major cardiovascular events (death from cardiovascular disease, non-fatal stroke or non-fatal myocardial infarction (MI)), all cardiovascular events (major cardiovascular event or peripheral arterial disease or transient ischaemic attack), and all-cause mortality. Secondary outcome measures were major coronary events (fatal and non-fatal MI), major cerebrovascular events (fatal and non-fatal stroke), nephropathy (new or worsening renal disease), and all cancer. RESULTS: At baseline, 6466 (56% women) participants were never-smokers, 1550 (28% women) were daily smokers and 3124 (21% women) were former smokers. Median follow-up time was 5 years. In Cox regression models after multiple adjustments, compared with never smoking, daily smoking was associated with increased risk of all primary and secondary outcomes with the exception of major cerebrovascular disease. Only for major coronary events was there any evidence of a stronger effect in women than in men (ratio of the adjusted HRs women:men; 1.64 (0.83 to 3.26) p=0.08). For all other outcomes considered, the hazards of smoking were similar in men and women. Quitting smoking was associated with a 30% reduction in all-cause mortality (p=0.001) in both sexes. CONCLUSIONS: In individuals with diabetes, the effects of smoking on all major forms of cardiovascular disease are equally as hazardous in women and men with the possible exception of major coronary events where there was some evidence of a greater hazard in women. TRIAL REGISTRATION NUMBER: NCT00145925.

AD - The George Institute for Global Health, Sydney, New South Wales, Australia.
The George Institute for Global Health, Sydney, New South Wales, Australia Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
The George Institute for Global Health, Sydney, New South Wales, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Imperial College and St Mary's Hospital, London, UK.
University of Milan-Bicocca and Instituto Auxologico Italiano, Milan, Italy.
The George Institute for Global Health, Sydney, New South Wales, Australia School of Public Health, Curtin University, Perth, Western Australia, Australia. AN - 26747037 BT - BMJ Open DA - 93562401117 DP - NLM ET - 2016/01/10 LA - eng LB - AUS
UK
CDV
PDO
FP
FY16 M1 - 1 N1 - Blomster, Juuso I
Woodward, Mark
Zoungas, Sophia
Hillis, Graham S
Harrap, Stephen
Neal, Bruce
Poulter, Neil
Mancia, Giuseppe
Chalmers, John
Huxley, Rachel
England
BMJ Open. 2016 Jan 8;6(1):e009668. doi: 10.1136/bmjopen-2015-009668. N2 -

OBJECTIVES: In general populations, the adverse effects of smoking on coronary risk have been demonstrated to be greater in women than in men; whether this is true for individuals with diabetes is unclear. DESIGN: Cohort study. SETTING: 20 countries worldwide participating in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial. PARTICIPANTS: 11 140 patients with type 2 diabetes aged >/=55 years and in cardiovascular risk at the time of randomisation. PRIMARY AND SECONDARY OUTCOME MEASURES: Major cardiovascular events (death from cardiovascular disease, non-fatal stroke or non-fatal myocardial infarction (MI)), all cardiovascular events (major cardiovascular event or peripheral arterial disease or transient ischaemic attack), and all-cause mortality. Secondary outcome measures were major coronary events (fatal and non-fatal MI), major cerebrovascular events (fatal and non-fatal stroke), nephropathy (new or worsening renal disease), and all cancer. RESULTS: At baseline, 6466 (56% women) participants were never-smokers, 1550 (28% women) were daily smokers and 3124 (21% women) were former smokers. Median follow-up time was 5 years. In Cox regression models after multiple adjustments, compared with never smoking, daily smoking was associated with increased risk of all primary and secondary outcomes with the exception of major cerebrovascular disease. Only for major coronary events was there any evidence of a stronger effect in women than in men (ratio of the adjusted HRs women:men; 1.64 (0.83 to 3.26) p=0.08). For all other outcomes considered, the hazards of smoking were similar in men and women. Quitting smoking was associated with a 30% reduction in all-cause mortality (p=0.001) in both sexes. CONCLUSIONS: In individuals with diabetes, the effects of smoking on all major forms of cardiovascular disease are equally as hazardous in women and men with the possible exception of major coronary events where there was some evidence of a greater hazard in women. TRIAL REGISTRATION NUMBER: NCT00145925.

PY - 2016 SN - 2044-6055 (Electronic) EP - e009668 T2 - BMJ Open TI - The harms of smoking and benefits of smoking cessation in women compared with men with type 2 diabetes: an observational analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial VL - 6 Y2 - FY16 ER -