Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study
BackgroundHeart 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 beh...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2024-01-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2024/1/e46450 |
| _version_ | 1797358048365248512 |
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| author | Jung Eun Yoo Su-Min Jeong Kyu Na Lee Heesun Lee Ji Won Yoon Kyungdo Han Dong Wook Shin |
| author_facet | Jung Eun Yoo Su-Min Jeong Kyu Na Lee Heesun Lee Ji Won Yoon Kyungdo Han Dong Wook Shin |
| author_sort | Jung Eun Yoo |
| collection | DOAJ |
| description |
BackgroundHeart 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.
ObjectiveWe aimed to examine the association between interval changes in smoking behavior and the risk of HF among patients with type 2 diabetes.
MethodsWe 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.
ResultsDuring 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.
ConclusionsSmoking 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. |
| first_indexed | 2024-03-08T14:54:11Z |
| format | Article |
| id | doaj.art-3a6666e5991e488c8e6803d60413dd59 |
| institution | Directory Open Access Journal |
| issn | 2369-2960 |
| language | English |
| last_indexed | 2024-03-08T14:54:11Z |
| publishDate | 2024-01-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Public Health and Surveillance |
| spelling | doaj.art-3a6666e5991e488c8e6803d60413dd592024-01-10T15:45:35ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602024-01-0110e4645010.2196/46450Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort StudyJung Eun Yoohttps://orcid.org/0000-0001-8344-6291Su-Min Jeonghttps://orcid.org/0000-0001-9588-1928Kyu Na Leehttps://orcid.org/0000-0003-3011-8010Heesun Leehttps://orcid.org/0000-0003-4037-3955Ji Won Yoonhttps://orcid.org/0000-0001-9003-0614Kyungdo Hanhttps://orcid.org/0000-0002-6096-1263Dong Wook Shinhttps://orcid.org/0000-0001-8128-8920 BackgroundHeart 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. ObjectiveWe aimed to examine the association between interval changes in smoking behavior and the risk of HF among patients with type 2 diabetes. MethodsWe 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. ResultsDuring 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. ConclusionsSmoking 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.https://publichealth.jmir.org/2024/1/e46450 |
| spellingShingle | Jung Eun Yoo Su-Min Jeong Kyu Na Lee Heesun Lee Ji Won Yoon Kyungdo Han Dong Wook Shin Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study JMIR Public Health and Surveillance |
| title | Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study |
| title_full | Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study |
| title_fullStr | Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study |
| title_full_unstemmed | Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study |
| title_short | Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study |
| title_sort | smoking behavior change and the risk of heart failure in patients with type 2 diabetes nationwide retrospective cohort study |
| url | https://publichealth.jmir.org/2024/1/e46450 |
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