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

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, diabetes duration, hypoglycaemic treatment, haemoglobin A_1c, 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.

Keywords

cardiovascular diseases diabetes myocardial infarction smoking stroke

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