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Smoking as an independent risk factor for myocardial infarction or stroke in type 2 diabetes: a report from the Swedish National Diabetes Register.

Nilsson, Peter LU ; Cederholm, Jan; Eeg-Olofsson, Katarina; Eliasson, Björn; Zethelius, Björn; Fagard, Robert and Gudbjörnsdóttir, Soffia (2009) In European Journal of Cardiovascular Prevention & Rehabilitation 16. p.506-512
Abstract
BACKGROUND: Few earlier studies have analysed smoking as a risk factor for myocardial infarction (MI) or stroke in type 2 diabetic patients. DESIGN AND METHODS: A longitudinal study involved 13 087 female and male patients with type 2 diabetes from the Swedish National Diabetes Register with no previous MI or stroke at baseline, aged 30-74 years, and with data available for all analysed variables, followed up for mean 5.7 years. RESULTS: Adjusted hazard ratios (HRs) for smoking and first-incident fatal/nonfatal MI, stroke and total mortality were 1.7 [95% confidence interval (CI): 1.4-2.0; P<0.001], 1.3 (95% CI: 1.1-1.6; P = 0.006) and 1.8 (95% CI: 1.5-2.2; P<0.001), respectively, by Cox regression analysis, adjusted for age, sex,... (More)
BACKGROUND: Few earlier studies have analysed smoking as a risk factor for myocardial infarction (MI) or stroke in type 2 diabetic patients. DESIGN AND METHODS: A longitudinal study involved 13 087 female and male patients with type 2 diabetes from the Swedish National Diabetes Register with no previous MI or stroke at baseline, aged 30-74 years, and with data available for all analysed variables, followed up for mean 5.7 years. RESULTS: Adjusted hazard ratios (HRs) for smoking and first-incident fatal/nonfatal MI, stroke and total mortality were 1.7 [95% confidence interval (CI): 1.4-2.0; P<0.001], 1.3 (95% CI: 1.1-1.6; P = 0.006) and 1.8 (95% CI: 1.5-2.2; P<0.001), respectively, by Cox regression analysis, adjusted for age, sex, diabetes duration, hypoglycaemic treatment, haemoglobin A1c, blood pressure, body mass index, microalbuminuria, antihypertensive and lipid-lowering drugs. Adjusted HR was higher for fatal MI, 2.1 (95% CI: 1.7-2.7; P<0.001), than for nonfatal MI, 1.4 (95% CI: 1.2-1.7; P<0.001). The highest HRs were observed in more frequently smoking (22%), middle-aged patients (age <60 years) for fatal/nonfatal MI, 2.3 (95% CI: 1.8-3.1; P<0.001) and for total mortality, 2.5 (95% CI: 1.6-3.8, P<0.001), whereas lower HRs were observed in older and less smoking patients. With predicted cessation of smoking in patients aged below 60 years, 24% (95% CI: 15-33%) of cases of fatal/nonfatal MI and 24% (11-37%) of cases of total mortality may have been prevented. CONCLUSION: The risk for MI and total mortality associated with smoking is high in type 2 diabetes, especially in more frequently smoking, middle-aged patients, and was higher for MI than for stroke, and also higher for fatal than for nonfatal events. Smoking cessation would strongly affect risk reduction. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Cardiovascular Prevention & Rehabilitation
volume
16
pages
506 - 512
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000268869400015
  • pmid:19561510
  • scopus:70349194930
ISSN
1741-8275
DOI
10.1097/HJR.0b013e32832ccc50
language
English
LU publication?
yes
id
cd009552-6de9-4c5c-8e3f-01aafc4c7e25 (old id 1433798)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19561510?dopt=Abstract
date added to LUP
2009-07-06 11:31:05
date last changed
2017-07-23 04:51:29
@article{cd009552-6de9-4c5c-8e3f-01aafc4c7e25,
  abstract     = {BACKGROUND: Few earlier studies have analysed smoking as a risk factor for myocardial infarction (MI) or stroke in type 2 diabetic patients. DESIGN AND METHODS: A longitudinal study involved 13 087 female and male patients with type 2 diabetes from the Swedish National Diabetes Register with no previous MI or stroke at baseline, aged 30-74 years, and with data available for all analysed variables, followed up for mean 5.7 years. RESULTS: Adjusted hazard ratios (HRs) for smoking and first-incident fatal/nonfatal MI, stroke and total mortality were 1.7 [95% confidence interval (CI): 1.4-2.0; P&lt;0.001], 1.3 (95% CI: 1.1-1.6; P = 0.006) and 1.8 (95% CI: 1.5-2.2; P&lt;0.001), respectively, by Cox regression analysis, adjusted for age, sex, diabetes duration, hypoglycaemic treatment, haemoglobin A1c, blood pressure, body mass index, microalbuminuria, antihypertensive and lipid-lowering drugs. Adjusted HR was higher for fatal MI, 2.1 (95% CI: 1.7-2.7; P&lt;0.001), than for nonfatal MI, 1.4 (95% CI: 1.2-1.7; P&lt;0.001). The highest HRs were observed in more frequently smoking (22%), middle-aged patients (age &lt;60 years) for fatal/nonfatal MI, 2.3 (95% CI: 1.8-3.1; P&lt;0.001) and for total mortality, 2.5 (95% CI: 1.6-3.8, P&lt;0.001), whereas lower HRs were observed in older and less smoking patients. With predicted cessation of smoking in patients aged below 60 years, 24% (95% CI: 15-33%) of cases of fatal/nonfatal MI and 24% (11-37%) of cases of total mortality may have been prevented. CONCLUSION: The risk for MI and total mortality associated with smoking is high in type 2 diabetes, especially in more frequently smoking, middle-aged patients, and was higher for MI than for stroke, and also higher for fatal than for nonfatal events. Smoking cessation would strongly affect risk reduction.},
  author       = {Nilsson, Peter and Cederholm, Jan and Eeg-Olofsson, Katarina and Eliasson, Björn and Zethelius, Björn and Fagard, Robert and Gudbjörnsdóttir, Soffia},
  issn         = {1741-8275},
  language     = {eng},
  pages        = {506--512},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {European Journal of Cardiovascular Prevention & Rehabilitation},
  title        = {Smoking as an independent risk factor for myocardial infarction or stroke in type 2 diabetes: a report from the Swedish National Diabetes Register.},
  url          = {http://dx.doi.org/10.1097/HJR.0b013e32832ccc50},
  volume       = {16},
  year         = {2009},
}