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High coronary risks in female smokers with diabetes

High coronary risks in female smokers with diabetes

Publication date: Wednesday, 23 March 2016
Contributor(s): Jeremy Bray

In people with diabetes, the effects of smoking on cardiovascular disease are equally hazardous in women and men, but women seem to be at greater risk of major coronary events, according to a new multicentre study.

In the UK, the prevalence of smoking in people with diabetes is similar to that seen in the general population (20-25%). The ADVANCE trial investigated smoking-associated risks in men and women with type 2 diabetes. The trial included 11,140 patients (>55 years of age) with type 2 diabetes from 20 countries. The study divided participants into never smokers, daily smokers and former smokers and followed them for a median of 5 years. Primary outcomes included major cardiovascular (CV) events, all CV events and all-cause mortality. Secondary events included major coronary events, major cerebrovascular events, nephropathy and all cancer.

As expected, daily smoking was associated with increased risk of all primary and secondary outcomes (with the exception of major cerebrovascular disease) in both sexes, compared with those that never smoked (Table 1).

Table 1: Increased risk of daily smoking in people with type 2 diabetes compared with those that never smoked.

Primary outcomes

Hazard ratio (95% CI)


Major cardiovascular

1.26 (1.04 – 1.53)


All cardiovascular

1.26 (1.11-1.44)


All cause mortality

1.67 (1.36 – 2.04)


The risks of smoking were similar between men and women although there was evidence of a stronger impact on women for major coronary events (adjusted HR 1.64 [0.83 to 3.26] p=0.08) (Table 2).

Table 2: Ratio of the risks between men and women for daily smoking vs no smoking.

Selected outcomes

Hazard ratio (95% CI)


Major cardiovascular

0.97 (0.63 -1.50)


All cardiovascular

1.02 (0.77-1.34)


All cause mortality

1.06 (0.69-1.64)


Major coronary events

1.64 (0.83-3.26)


The benefits of quitting smoking were similar between men and women and included a 30% reduction (HR 0.70 [95% CI 0.57 to 0.87) in all-cause mortality (p=0.001).


This article provides further data to support the need for smoking cessation in people with diabetes, and highlights the specific risks to women.

Blomster J, et al. The harms of smoking and benefits of smoking cessation in women compared with men in type 2 diabetes: an observational analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release controlled evaluation) trial. BMJ Open 2016;6:e009668 doi:10.1136/bmjopen-2015-009668

Topics covered:
Category: Evidence in Practice
Edition: Volume 1, Number 3, BJPCN Online 2016
Contributor(s): Jeremy Bray

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