title: Relation of Smoking With Total Mortality and Cardiovascular Events Among Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review.
abstract: BACKGROUND
  The prevalence of smoking in diabetic patients remains high, and reliable quantification of the excess mortality and morbidity risks associated with smoking is important for diabetes management. We performed a systematic review and meta-analysis of prospective cohort studies to evaluate the relation of active smoking with risk of total mortality and cardiovascular events among diabetic patients.
  
  
  RESULTS
  We searched Medline and Embase databases through May 2015, and multivariate-adjusted relative risks were pooled by using random-effects models. A total of 89 cohort studies were included. The pooled adjusted relative risk (95% confidence interval) associated with smoking was 1.55 (1.46-1.64) for total mortality (48 studies with 1,132,700 participants and 109,966 deaths), and 1.49 (1.29-1.71) for cardiovascular mortality (13 studies with 37,550 participants and 3163 deaths). The pooled relative risk (95% confidence interval) was 1.44 (1.34-1.54) for total cardiovascular disease (16 studies), 1.51 (1.41-1.62) for coronary heart disease (21 studies), 1.54 (1.41-1.69) for stroke (15 studies), 2.15 (1.62-2.85) for peripheral arterial disease (3 studies), and 1.43 (1.19-1.72) for heart failure (4 studies). In comparison with never smokers, former smokers were at a moderately elevated risk of total mortality (1.19; 1.11-1.28), cardiovascular mortality (1.15; 1.00-1.32), cardiovascular disease (1.09; 1.05-1.13), and coronary heart disease (1.14; 1.00-1.30), but not for stroke (1.04; 0.87-1.23).
  
  
  CONCLUSIONS
  Active smoking is associated with significantly increased risks of total mortality and cardiovascular events among diabetic patients, whereas smoking cessation is associated with reduced risks in comparison with current smoking. The findings provide strong evidence for the recommendation of quitting smoking among diabetic patients.
authors: From Department of Epidemiology and Biostatistics, and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China (A.P.); Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore (Y.W., M.T.); Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.B.H.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.). panan@hust.edu.cn.
authors: An
authors: A
authors: Pan
authors: From Department of Epidemiology and Biostatistics, and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China (A.P.); Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore (Y.W., M.T.); Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.B.H.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
authors: Yeli
authors: Y
authors: Wang
authors: From Department of Epidemiology and Biostatistics, and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China (A.P.); Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore (Y.W., M.T.); Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.B.H.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
authors: Mohammad
authors: M
authors: Talaei
authors: From Department of Epidemiology and Biostatistics, and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China (A.P.); Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore (Y.W., M.T.); Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.B.H.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
authors: Frank B
authors: FB
authors: Hu
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D009026:Mortality / Q000639:trends; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality* / Q000628:therapy; D016540:Smoking Cessation
keywords: diabetes mellitus; epidemiology; follow-up studies; meta-analysis; smoking