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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.

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