March 27, 2013
Weight Gain Doesn’t Negate Beneficial Effects
of Smoking Cessation

Lausanne, Switzerland—When they counsel about smoking cessation, pharmacists often get pushback from smokers who are afraid they will gain weight if they quit. Some even point out that putting on pounds would also be bad for their health.

That may be true, but it is still a good trade-off compared to continuing to smoke, according to a new study.

The study, published recently in the Journal of the American Medical Association, found that, for adults without diabetes, quitting smoking was associated with a lower risk of cardiovascular disease even with weight gain.

“Cigarette smoking is the leading cause of preventable mortality in the United States and a major risk factor for cardiovascular disease (CVD). Smoking cessation substantially reduces the risks of CVD; however, quitting smoking is associated with a small number of adverse health consequences, weight gain being one of smokers’ major concerns,” according to the article’s background information.

Researchers led by Carole Clair, MD, MSc, of the University of Lausanne in Switzerland, used data from the Framingham Offspring Study, collected from 1984 through 2011, to assess the association between 4-year weight gain following smoking cessation and CVD incidence.

During the Framingham study, self-reported smoking status was assessed every 4 years and categorized as smoker, recent quitter (≤ 4 years), long-term quitter (>4 years), and nonsmoker. Clair and her colleagues used models to estimate the association between quitting smoking and 6-year CVD events, as well as to shed light on whether 4-year change in weight following smoking cessation modified the association between smoking cessation and CVD events

CVD events, including coronary heart disease, cerebrovascular events, peripheral artery disease, and congestive heart failure, were the primary outcome measures of the study.

Weight gain over 4 years was a significant issue for some participants: Those without diabetes who had recently given up smoking gained more weight (median 5.9 lbs.) than long-term quitters (1.9 lbs.), smokers (1.9 lbs.), and nonsmokers (3 lbs.).

Patients with diabetes who recently quit smoking gained even more weight, 7.9 lbs., especially compared to those with diabetes who continued to smoke (1.9 lbs.), long-term quitters (0.0 lbs.), and nonsmokers (1.1 lbs.), according to the study.

During follow-up for an average of 25 years, 631 CVD events occurred among 3,251 participants, with rates lower for nonsmokers, recent quitters, and long-term quitters without diabetes, compared to smokers.

In fact, compared to smokers, those recent quitters had a 53% lower risk for CVD, and long-term quitters had a 54% lower risk for CVD.

“Among participants with diabetes, there were similar point estimates that did not reach statistical significance,” the authors write.

The authors note that obesity is also a risk factor for CVD and that, theoretically, weight gain following smoking cessation could decrease the benefits of quitting smoking on CVD outcomes. In patients with diabetes, they add, weight gain following smoking cessation also could lead to poor diabetes control, which could trigger other serious issues.

“The effect on CVD of potential weight gain following smoking cessation is not well understood,” the authors write.

The researchers observed similar benefits associated with smoking cessation for total CVD and for fatal and nonfatal coronary heart disease, with the cessation benefits not offset by weight gain.

“In conclusion, among adults without diabetes, quitting smoking was associated with a lower risk of CVD compared with continuing smoking,” according to the study. “There were qualitatively similar lower risks among participants with diabetes that did not reach statistical significance, possibly because of limited study power. Weight gain that occurred following smoking cessation was not associated with a reduction in the benefits of quitting smoking on CVD risk among adults without diabetes. This supports a net cardiovascular benefit of smoking cessation, despite subsequent weight gain.”

In an accompanying editorial, Michael C. Fiore, MD, MPH, MBA, and Timothy B. Baker, PhD, of the University of Wisconsin School of Medicine and Public Health in Madison, suggested that health care providers could use the study results to “reassure patients concerned about the health effects of cessation-related weight gain.”

The commentators note that about 50% percent of female smokers and about 25% of male smokers are “weight concerned,” and that could discourage them from attempting or succeeding with smoking cessation.

U.S. Pharmacist Social Connect