Tobacco.org

The role of secondhand smoking on the prevalence of type 2 diabetes mellitus in elderly men and women living in Mediterranean islands: the MEDIS study  

Jump to full article »

• Exposure to secondhand smoke increases risk for Type 2 diabetes 

Chronic secondhand smoke exposure significantly increases the risk for Type 2 diabetes, show results from a study of Greek and Cypriot elderly men and women.

“While active smoking is strongly related to the development of diabetes mellitus, the role of exposure to secondhand smoke in the development of diabetes mellitus is unclear,” write Demosthenes Panagiotakos (Harokopio University, Athens, Greece) and colleagues in the journal Diabetic Medicine.

The researchers recruited 1190 elderly men and women aged 65 years or above from several Greek and Cypriot islands in the Mediterranean during 2005–2007.

Jump to full article »

Opinion Former Briefing: Smoking ban reduces heart attacks  

The Royal College of Physicians commented:

"This is fantastic news - it shows that public policy measures can be really effective in changing people's behaviours and saving lives."

The Stroke Association commented:

“The long running campaign against smoking has saved thousands of lives and the latest research showing that the smoking ban is having such a big impact is a welcome sign that we can continue to reduce deaths and illness due to smoking. . . .

Diabetes UK commented: “we support the smoking ban and we are pleased to hear that it may reduce the number of heart attacks by more than a third in countries where it is implemented.

Jump to full article »

Smoking as an independent risk factor for myocardial infarction or stroke in type 2 diabetes: a report from the Swedish National Diabetes Register  

Discussion

This observational study of patients with type 2 diabetes showed that the HR was high for fatal/nonfatal MI and total mortality in relation to smoking, especially in middle-aged more frequently smoking patients (HR 2.3 and 2.4). The HR for smoking and risk of fatal/nonfatal MI was higher than for smoking and fatal/nonfatal stroke (HR 1.7 vs. 1.3), especially in more frequently smoking (22%), middle-aged patients (HR 2.3 vs. 1.1). Furthermore, the HR was also higher for fatal than for nonfatal MI (HR 2.1 vs. 1.4). The highest PARp was observed for MI and total mortality in more frequently smoking, middle-aged patients (24%). . . .

According to our findings, and as also pointed out in recent clinical guidelines for diabetes care [31], smoking cessation should be a main target for the prevention of CVDs in patients with type 2 diabetes, and is also very cost-effective [32]. New methods to improve the quit rate of smokers include both nondrug (structural) [32] and drug-based methods [33], which might be particularly helpful in patients with diabetes. As PARp for CVDs and mortality should vary with differing frequencies of smoking, as observed in this study with the highest PARp for MI and total mortality in more frequently smoking, middle-aged patients, this implies that smoking cessation should be integrated in a multiple risk factor control programme. This was shown in the Steno-2 trial, where a decrease in smoking rate was combined with a successful decrease in other risk factors in the intensively treated group [34]. . . .

In conclusion, smoking is not only a long-term risk factor for type 2 diabetes [36], but also an important and independent cardiovascular risk factor in patients with established type 2 diabetes. The relative risk related to smoking was high for MI and total mortality, especially in middle-aged, more frequently smoking patients, and was higher for MI than for stroke, fatal than for nonfatal events. The highest partial PARp was observed for MI and total mortality in middle-aged, more frequently smoking patients. These findings should be considered for preventive programmes in patients with type 2 diabetes because of their high risk of CVDs.

Jump to full article »

Smoking increases risk for MI and death in Type 2 diabetics 

Study results show that smoking significantly increases the risk for myocardial infarction (MI) and death in individuals with Type 2 diabetes, a group already at higher risk for cardiovascular disease than the general population.

“Smoking is one of the classical risk factors for cardiovascular disease (CVD) besides hypertension, hyperlipidemia, and diabetes, and contributes substantially to the global burden of disease,” say Peter Nillson (Lund University, Malm�, Sweden) and colleagues.

Researchers from the Swedish National Diabetes Register carried out a longitudinal study of 13,087 men and women with Type 2 diabetes, who had no previous MI or stroke at baseline, to assess the effect of smoking versus nonsmoking on risk for CVD.

The participants were aged 30–74 years at baseline and were followed up for an average period of 5.7 years.

Writing in the European Journal of Cardiovascular Prevention and Rehabilitation, the team reports that the adjusted risks for fatal or nonfatal MI, stroke, and total mortality were 70%, 30%, and 80% higher for participants who smoked (n=2150) than for those who did not smoke.

Jump to full article »

Smoking, High Blood Pressure And Diabetes In Mid-life Can Lead To Dementia 

Middle aged people who smoke, have high blood pressure or diabetes are far more likely to develop dementia in later life, suggests research published ahead of print in the Journal of Neurology, Neurosurgery and Psychiatry.

People should consider modifying their lifestyle in mid-life to avoid developing dementia, claims the US research.

Dementia is a growing public health problem affecting older people in developed countries. In the US, where the research took place, estimates show that one in six people older than 70 have dementia. Estimates are that the number of people with dementia will grow threefold by 2050, compared with 2000.

Previous studies have shown that the presence of cardiovascular risk factors including high blood pressure, diabetes, obesity and smoking increase the risk of developing subsequent dementia, but have often failed to show the relationship.

Researchers from the universities of Minnesota, North Carolina and John Hopkins and the University of Mississippi Medical Center studied more than 11,000 people aged 46-70 who were participants in the Atherosclerosis Risk in Communities (ARIC) study in 1990-92.

Jump to full article »

Smoking link with STEMI risk raised in younger and female patients 

MedWire News: Tobacco smoking is a major risk factor for the development of ST-segment elevation myocardial infarction (STEMI), with the greatest impact seen in younger patients and women, warn Swedish investigators.

The observed increase in the proportion of milder, non-STEMI cases in recent years may be a result of improved patient management and more sensitive diagnostic tools, argues Lean Björk, from Sahlgrenska Academy University of Gothenburg, and colleagues.

Noting, however, that there have also been changes in risk factors, the team examined data on 93,416 patients aged 25–84 years who were admitted to hospital between 1996 and 2004 with acute MI, extracting information on demographic and clinical characteristics, presentation, investigations, management, and tobacco status. . . .

The team concludes: “Overall, tobacco smoking was associated with an increased risk for presenting with ST-elevation, particularly among younger patients and women patients. These results underline the importance of smoking as a major risk factor for presenting with more severe acute MIs.”

Jump to full article »

REVIEW: Smoking and hormones in health and endocrine disorders  

Smoking has multiple effects on hormone secretion, some of which are associated with important clinical implications. These effects are mainly mediated by the pharmacological action of nicotine and also by toxins such as thiocyanate. Smoking affects pituitary, thyroid, adrenal, testicular and ovarian function, calcium metabolism and the action of insulin. The major salient clinical effects are the increased risk and severity of Graves’ hyperthyroidism and opthalmopathy, osteoporosis and reduced fertility. Smoking also contributes to the development of insulin resistance and hence type 2 diabetes mellitus. An important concern is also the effect of smoking on the foetus and young children. Passive transfer of thiocyanate can cause disturbance of thyroid size and function. Furthermore, maternal smoking causes increased catecholamine production, which may contribute to under perfusion of the foetoplacental unit. . . .

In males, the effect of smoking on androgen levels is important, given the recent interest in the association between low androgen levels and the metabolic syndrome, and coronary heart disease (90). Various studies examining the effects of smoking on serum testosterone levels have reported conflicting findings largely due to difficulties in the hormonal assays. Testosterone has a circadian rhythm with levels peaking between 0600 and 0800 h and reaching a nadir between 1800 and 2000 h. A significant proportion of the circulating total testosterone is inactive as it is tightly bound to SHBG (65–80%), whereas the biologically active fraction circulates either free (1–3%) in circulation or loosely bound to albumin (20–40%). The free plus the albumin-bound testosterone is called the bioavailable testosterone. Thus levels of total testosterone can be affected by changes in the levels of SHBG and other plasma proteins. Significantly increased (41, 91–95), decreased (96, 97) and unchanged levels of total testosterone (64, 98, 99) in male smokers have been reported in various studies. Free testosterone levels have also been found to be higher among smokers (41, 91, 92, 94, 95). However, SHBG levels have been measured only in three studies (92, 93, 95) and are reported to be higher amongst smokers. No significant differences in the levels of bioavailable testosterone have been demonstrated between smokers and non-smokers (92, 93). English and colleagues (92) demonstrated that the increase in total testosterone observed in smokers is due to the raised SHBG levels. They also reported that SHBG levels and not testosterone correlated with serum nicotine levels, a measure of cigarette smoking. However, Svartberg et al. (95) found a positive association between testosterone and smoking even after adjusting for SHBG though other plasma proteins were not taken into account. It would seem likely that the effects of smoking on testosterone levels are due to changes in plasma-binding capacity rather than a direct effect of nicotine on androgens. . . .

Smoking is an important modifier of hormones and a detailed smoking history is essential when assessing patients with endocrine disorders. The hormonal responses to smoking are responsible for the increased prevalence of several diseases in smokers. Graves’ disease and particularly Graves’ ophthalmopathy are strongly associated with smoking. Autoimmune thyroiditis and small goiters are also more commonly seen in smokers. Similarly, osteoporosis is linked to smoking through its effects on various hormones, in particular the anti-oestrogenic effect in women, which causes fertility problems and premature menopause in smokers as well. Insulin resistance is also more common in smokers and may contribute to the increased incidence of cardiovascular disease. More pronounced responses are seen in heavy smokers as compared with light smokers reflecting the direct toxicogenic effect of cigarette smoke. Maternal smoking affects the infants in a similar way to adults. It is also possible that passive smoking could also affect the growth of young children through decrease in GH, as seen in chronic smokers. The rewards of giving up smoking are thus both immediate and substantial.

Jump to full article »

Nicotine Induces Prediabetes, Likely Contributes to High Prevalence of Heart Disease in Smokers 

Researchers have discovered a reason why smoking greatly increases the risk of heart disease and stroke. Nicotine promotes insulin resistance, also called prediabetes, which is a risk factor for cardiovascular disease, according to the new study, which was presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

Additionally, the study authors were able to partially reverse this harmful effect of nicotine in mice by treating them with the nicotine antagonist mecamylamine, a drug that blunts the action of nicotine.

The study, which the National Institutes of Health funded, was conducted by researchers at Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona, Calif.

Their results may explain why cigarette smokers have a high cardiovascular death rate, even though “smoking causes weight loss, which should protect against heart disease,” said the study’s lead author, Theodore Friedman, MD, PhD, chief of the endocrinology division at Charles Drew University.

Jump to full article »

Why Smoking Increases The Risk Of Heart Disease And Strokes 

Researchers at Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona have discovered a reason why smoking increases the risk of heart disease and strokes.

The study, which was presented at The Endocrine Society's 91st annual meeting in Washington, D.C., found that nicotine in cigarettes promotes insulin resistance, a pre-diabetic condition that raises blood sugar levels higher than normal. People with pre-diabetes are at greater risk of developing cardiovascular disease.

Theodore Friedman, MD, Ph.D., chief of the endocrinology division at Charles Drew University, said the findings help explain a "paradox" that links smoking to heart disease.

Smokers experience a high degree of cardiovascular deaths, Friedman said. "This is surprising considering both smoking and nicotine may cause weight loss and weight loss should protect against cardiovascular disease."

The researchers studied the effects of twice-daily injections of nicotine on 24 adult mice over two weeks. The nicotine-injected mice ate less food, lost weight and had less fat than control mice that received injections without nicotine.

"Our results in mice show that nicotine administration leads to both weight loss and decreased food intake," Friedman said. "Mice exposed to nicotine have less fat. In spite of this, mice have abnormal glucose tolerance and are insulin resistant (pre-diabetes)."

Jump to full article »

• Effects of Timing and Extent of Smoking, Type of Cigarettes, and Concomitant Risk Factors on the Association Between Smoking and Subclinical Atherosclerosis  

The purpose of this study was to evaluate the effects of timing and extent of smoking, type of cigarettes, and concomitant vascular risk factors (VRFs) on the association between smoking and carotid intima-media thickness (C-IMT) in a lipid clinic population. . . .

Conclusions-- In the present cross-sectional observational investigation, carried out in a cohort of patients attending a lipid clinic, consumption of light cigarettes does not reduce the atherogenic effect of smoking on C-IMT. The number of pack-years, cigarettes/d, and years of smoking are relevant covariates in evaluating the effects of smoking on vascular health. The presence of diabetes or hypertension strengthens the association between smoking and cardiovascular risk.

Jump to full article »

Lifestyle May Counter Blood Pressure Genes  

Being born with genes that predispose you to high blood pressure doesn't mean you're doomed to have it, a long-term study shows.

"It's been known for many years that blood pressure is affected by genes," said Dr. Nora Franceschini, an assistant professor of epidemiology at the University of North Carolina and lead author of a report on the study. "It's also known that lifestyle affects blood pressure. Now we are showing that they interact, and that the effect of those genes varies among individuals who have different behaviors."

It's an important finding because high blood pressure is a major risk factor for heart attack, stroke and other cardiovascular diseases. The study, reported online Tuesday in Circulation: Cardiovascular Genetics, "reinforces the message that lifestyle changes can alter the effect of genetics," Franceschini said.

That message comes from the Strong Heart Family Study, which has been looking at diabetes and high blood pressure among American Indians in Arizona, North and South Dakota and Oklahoma, an ethnic group in which the incidence of both is high. The study now includes more than 3,600 people aged 14 to 93.

Jump to full article »

Nicotine induces prediabetes, likely contributes to high prevalence of heart disease in smokers 

Researchers have discovered a reason why smoking greatly increases the risk of heart disease and stroke. Nicotine promotes insulin resistance, also called prediabetes, which is a risk factor for cardiovascular disease, according to the new study, which was presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C.

Additionally, the study authors were able to partially reverse this harmful effect of nicotine in mice by treating them with the nicotine antagonist mecamylamine, a drug that blunts the action of nicotine.

The study, which the National Institutes of Health funded, was conducted by researchers at Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona, Calif.

Their results may explain why cigarette smokers have a high cardiovascular death rate, even though "smoking causes weight loss, which should protect against heart disease," said the study's lead author, Theodore Friedman, MD, PhD, chief of the endocrinology division at Charles Drew University.

Jump to full article »

Why smoking may increase heart risk  

.S. researchers suggest nicotine may be a reason smoking increases the risk of cardiovascular diseases.

Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona, Calif., said the studies in animals found nicotine promotes insulin resistance -- a prediabetic condition where blood-sugar levels are above normal.

Other studies show people with prediabetes are at greater risk of developing stroke, heart attack and other cardiovascular diseases.

Jump to full article »

Nicotine May Help Spur 'Prediabetes'  

The nicotine in cigarette smoke may promote insulin resistance and lead to a condition known as prediabetes, new research shows.

The finding, to be outlined Thursday at the Endocrine Society's annual meeting in Washington, D.C., could explain why smokers are at higher risk for diabetes. The same team of researchers was able to partially reverse nicotine's effect on insulin in mice by giving the rodents the nicotine-blunting drug mecamylamine.

In a society news release, study author Dr. Theodore Friedman, chief of the division of endocrinology, metabolism and molecular medicine at Charles R. Drew University of Medicine and Science in Los Angeles, noted that smokers tend to face a higher diabetes risk, even though "smoking causes weight loss, which should protect against heart disease."

But prior studies have shown smokers to be more insulin-resistant, which leads to higher blood-sugar levels. Some studies had suggested that the key factor at work was nicotine's effect on the stress hormone cortisol, since, as Friedman said, "cortisol excess is known to induce insulin resistance."

Jump to full article »