title: The harms of smoking and benefits of smoking cessation in women compared with men with type 2 diabetes: an observational analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial.
abstract: OBJECTIVE
  In general populations, the adverse effects of smoking on coronary risk have been demonstrated to be greater in women than in men; whether this is true for individuals with diabetes is unclear.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  20 countries worldwide participating in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial.
  
  
  METHODS
  11,140 patients with type 2 diabetes aged ≥ 55 years and in cardiovascular risk at the time of randomisation.
  
  
  METHODS
  Major cardiovascular events (death from cardiovascular disease, non-fatal stroke or non-fatal myocardial infarction (MI)), all cardiovascular events (major cardiovascular event or peripheral arterial disease or transient ischaemic attack), and all-cause mortality. Secondary outcome measures were major coronary events (fatal and non-fatal MI), major cerebrovascular events (fatal and non-fatal stroke), nephropathy (new or worsening renal disease), and all cancer.
  
  
  RESULTS
  At baseline, 6466 (56% women) participants were never-smokers, 1550 (28% women) were daily smokers and 3124 (21% women) were former smokers. Median follow-up time was 5 years. In Cox regression models after multiple adjustments, compared with never smoking, daily smoking was associated with increased risk of all primary and secondary outcomes with the exception of major cerebrovascular disease. Only for major coronary events was there any evidence of a stronger effect in women than in men (ratio of the adjusted HRs women:men; 1.64 (0.83 to 3.26) p=0.08). For all other outcomes considered, the hazards of smoking were similar in men and women. Quitting smoking was associated with a 30% reduction in all-cause mortality (p=0.001) in both sexes.
  
  
  CONCLUSIONS
  In individuals with diabetes, the effects of smoking on all major forms of cardiovascular disease are equally as hazardous in women and men with the possible exception of major coronary events where there was some evidence of a greater hazard in women.
  
  
  BACKGROUND
  NCT00145925.
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Juuso I
authors.initials: JI
authors.lastname: Blomster
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.affiliation: University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Harrap
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.affiliation: Imperial College and St Mary's Hospital, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.affiliation: University of Milan-Bicocca and Instituto Auxologico Italiano, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia School of Public Health, Curtin University, Perth, Western Australia, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Huxley
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D058729:Peripheral Arterial Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D016016:Proportional Hazards Models; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000188:drug therapy; D016540:Smoking Cessation; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D014029:Tobacco Use Disorder / Q000150:complications*
keywords: EPIDEMIOLOGY; PUBLIC HEALTH