02901nas a2200253   4500000000100000008004100001260001600042100001500058700001400073700001800087700001600105700001500121700001400136700001400150700001400164700001600178700001500194245026000209250001500469300001200484490000600496520211800502020002702620       2016                            d  c935624011171 aZoungas S.1 aHuxley R.1 aWoodward Mark1 aBlomster J.1 aPoulter N.1 aMancia G.1 aHarrap S.1 aHillis G.1 aChalmers J.1 aNeal Bruce00aThe 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  a2016/01/10  ae0096680 v63 a<p>
OBJECTIVES: 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. DESIGN: Cohort study. SETTING: 20 countries worldwide participating in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial. PARTICIPANTS: 11 140 patients with type 2 diabetes aged &gt;/=55 years and in cardiovascular risk at the time of randomisation. PRIMARY AND SECONDARY OUTCOME MEASURES: 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. TRIAL REGISTRATION NUMBER: NCT00145925.
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  a2044-6055 (Electronic)