Cardiometabolic Morbidity and Mortality with Smoking Cessation, Review of Recommendations for People with Diabetes and O
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LIFESTYLE MANAGEMENT TO REDUCE DIABETES/CARDIOVASCULAR RISK (B CONWAY AND H KEENAN, SECTION EDITORS)
Cardiometabolic Morbidity and Mortality with Smoking Cessation, Review of Recommendations for People with Diabetes and Obesity Katarina Kos 1 Accepted: 26 October 2020 / Published online: 8 December 2020 # The Author(s) 2020
Abstract Purpose of Review Obesity is closely linked with the pathogenesis of type 2 diabetes (T2DM) and cardiovascular disease (CVD), and whilst smoking cessation is associated with weight gain, there are concerns that this weight gain may offset the benefit of CVD risk reduction especially in those with considerable post-cessation weight gain. The aim of this narrative review is to evaluate recent evidence on smoking cessation and cardiometabolic outcomes and discuss limitations of current knowledge and studies. Recent Findings Nicotine is a key player in modulating energy balance by influencing lipid storage in adipose tissue by affecting lipolysis, energy input by modulating appetite and energy output by increasing sympathetic drive and thermogenesis. It also increases insulin resistance and promotes abdominal obesity. The CVD risk and mortality associated with cigarette smoking potentiate the CVD risks in patients with diabetes. Evidence supports the benefit of quitting cigarette smoking regardless of any subsequent weight gain. Data suggests that the cardiometabolic risk is limited to the first few years and that cardiovascular health and mortality benefit of smoking cessation outweighs the harm related to weight gain. This weight gain can be limited by nicotine replacement of which e-cigarettes (vaping) are increasingly popular if it is not an alternative to cigarette smoking. However, longterm health data on e-cigarettes is needed prior to formal recommendation for its use in smoking cessation. Summary The recommendation for cessation of cigarette smoking is justified for those at high risk of weight gain and diabetes. However, for most benefit, consideration should be given for personalized weight management to limit weight gain. Awareness of a ‘lean paradox’ by which lower weight is associated with increased CVD risk may help to improve motivation and insight into the bias of smoking, health and body composition otherwise known to epidemiologists as the ‘obesity paradox’. Keywords Smoking cessation . Type 2 diabetes . Nicotine . Tobacco . Obesity . E-cigarettes . Vaping
Introduction Smoking is pro-atherogenic and accelerates the progression of macro and microvascular disease and is an independent risk factor for premature mortality in patients with diabetes [1]. People with diabetes are a high-risk group for cardiovascular disease (CVD) even without smoking, mainly attributed to the chronic effects of hyperglycaemia. The American Diabetes This article is part of the Topical Collection on Lifestyle Management to Reduce Diabetes/Cardiovascular Risk * Katarina Kos [email protected] 1
Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, University of Exe
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