Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Studyopen access
- Authors
- Yoo, Jung Eun; Jeong, Su-Min; Lee, Kyu Na; Lee, Heesun; Yoon, Ji Won; Han, Kyungdo; Shin, Dong Wook
- Issue Date
- Jan-2024
- Publisher
- JMIR PUBLICATIONS, INC
- Keywords
- smoking; change in smoking behavior; cessation; heart failure; type 2 diabetes; diabetes; cardiovascular disease; smoking cessation; smoker; risk factor
- Citation
- JMIR PUBLIC HEALTH AND SURVEILLANCE, v.10
- Journal Title
- JMIR PUBLIC HEALTH AND SURVEILLANCE
- Volume
- 10
- URI
- https://scholarworks.bwise.kr/ssu/handle/2018.sw.ssu/49517
- DOI
- 10.2196/46450
- ISSN
- 2369-2960
- Abstract
- Background: Heart failure (HF) is one of the most common initial manifestations of cardiovascular disease in patients with type 2 diabetes. Although smoking is an independent risk factor for HF, there is a lack of data for the incidence of HF according to changes in smoking behaviors in patients with type 2 diabetes. Objective: We aimed to examine the association between interval changes in smoking behavior and the risk of HF among patients with type 2 diabetes. Methods: We conducted a retrospective cohort study using the National Health Insurance Service database. We identified 365,352 current smokers with type 2 diabetes who had 2 consecutive health screenings (2009-2012) and followed them until December 31, 2018, for the incident HF. Based on smoking behavior changes between 2 consecutive health screenings, participants were categorized into quitter, reducer I (>= 50% reduction) and II (<50% reduction), sustainer (reference group), and increaser groups. Results: During a median follow-up of 5.1 (IQR 4.0-6.1) years, there were 13,879 HF cases (7.8 per 1000 person-years). Compared to sustainers, smoking cessation was associated with lower risks of HF (adjusted hazard ratio [aHR] 0.90, 95% CI0.86-0.95), whereas increasers showed higher risks of HF than sustainers; heavy smokers who increased their level of smoking had a higher risk of HF (aHR 1.13, 95% CI 1.04-1.24). In the case of reducers, the risk of HF was not reduced but rather increased slightly (reducer I: aHR 1.14, 95% CI 1.08-1.21; reducer II: aHR 1.03, 95% CI 0.98-1.09). Consistent results were noted for subgroup analyses including type 2 diabetes severity, age, and sex. Conclusions: Smoking cessation was associated with a lower risk of HF among patients with type 2 diabetes, while increasing smoking amount was associated with a higher risk for HF than in those sustaining their smoking amount. There was no benefit from reduction in smoking amount.
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