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Smoking and Risk of Coronary Heart Disease Among Women With Type 2 Diabetes Mellitus
Wael K. Al-Delaimy, MD, PhD;
JoAnn E. Manson, MD, DrPH;
Caren G. Solomon, MD, MPH;
Ichiro Kawachi, MD, PhD;
Meir J. Stampfer, MD, DrPH;
Walter C. Willett, MD, DrPH;
Frank B. Hu, MD, PhD
Arch Intern Med. 2002;162:273-279.
Background Although the association between smoking and increased risk of coronary
heart disease (CHD) is well established in the general population, this relationship
is less well-defined among individuals with diabetes.
Objective To assess the relationship between cigarette smoking and risk of CHD
among women with type 2 diabetes mellitus in the Nurses' Health Study cohort.
Methods The Nurses' Health Study, a prospective cohort study of 121 700
US female registered nurses surveyed in 11 states and followed up from July
1, 1976, through July 1, 1996, involved a total of 6547 women diagnosed as
having type 2 diabetes mellitus. Incident cases of CHD were our main outcome
measure in this study.
Results We documented 458 incident cases of CHD (200 fatal CHD-related cases
and 258 nonfatal myocardial infarctions) during 20 years (68 227 person-years)
of follow-up. We found a dose-response relationship between current smoking
status and risk of CHD among diabetic women. Compared with never smokers,
the relative risks (RRs) for CHD were 1.21 (95% confidence interval [CI],
0.97-1.51) for past smokers, 1.66 (95% CI, 1.10-2.52) for current smokers
of 1 to 14 cigarettes per day, and 2.68 (95% CI, 2.07-3.48) for current smokers
of 15 or more cigarettes per day in multivariate analyses (P<.001 for trend). The multivariate RR of CHD among diabetic women
who had stopped smoking for more than 10 years was similar to that among diabetic
women who were never smokers (RR, 1.01; 95% CI, 0.73-1.38). In secondary analyses
involving diabetic and nondiabetic women, the multivariate-adjusted RR of
CHD for those with diabetes who currently smoked ( 15 cigarettes per day)
compared with those who never smoked was 7.67 (95% CI, 5.88-10.01).
Conclusions Cigarette smoking is strongly associated with an increased risk of CHD
among women with type 2 diabetes mellitus. Furthermore, quitting smoking seems
to decrease this excess risk substantially; women with diabetes should be
strongly advised against smoking.
From the Departments of Nutrition (Drs Al-Delaimy, Willett, and Hu),
Epidemiology (Drs Manson, Stampfer, and Willett), and Health and Social Behavior
(Dr Kawachi), Harvard School of Public Health, Boston, Mass; and the Channing
Laboratory (Drs Manson, Kawachi, Stampfer, and Willett) and the Divisions
of Preventive Medicine (Dr Manson) and General Medicine and Women's Health
(Dr Solomon), Department of Medicine, Harvard Medical School and Brigham and
Women's Hospital, Boston.
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