Author Insights: Excessive Weight Gain May Reduce the Benefits of Smoking Cessation for Heart Disease Risk

Juhua Luo, PhD, Indiana University in Bloomington, and colleagues found an association between smoking cessation and reduced risk for heart disease, although weight gain weakened this association. (Image: Indiana University)

Juhua Luo, PhD, Indiana University in Bloomington, and colleagues found an association between smoking cessation and reduced risk for heart disease, although weight gain weakened this association. (Image: Indiana University)

Cigarette smoking is a major risk factor for heart disease and quitting the habit reduces that risk. But smoking cessation is associated with gaining weight (on average from 6-13 pounds within 6 months after quitting), and weight gain is sometimes associated with increased risk for heart disease. Does that mean quitters might be substituting one heart disease risk factor for another? The authors of a research letter appearing today in JAMA, focusing on postmenopausal women with and without diabetes, say “no” in general, but perhaps “yes” if the weight gain is substantial.

The researchers, using data for 104391 postmenopausal women enrolled in the Women’s Health Initiative, found that among women without diabetes, those who recently quit (smoking at the start of the study and not smoking at year 3) decreased their risk of having a heart disease event (heart attack, silent heart attack, or death due to heart disease) by about 25% compared with women who were currently smoking. For former smokers (those not smoking either at the start of the study or at year 3), that risk was reduced by about 60%. For women with diabetes, both former smokers and those who recently quit reduced their risk by about 60% compared with women who smoked and had diabetes.

The reduction of heart disease risk from quitting smoking was maintained for all women whose weight gain remained less than 10 pounds but disappeared for women with diabetes who stopped smoking and who gained more than 10 pounds.

Lead author, Juhua Luo, PhD, an assistant professor in the epidemiology and biostatistics department at Indiana University in Bloomington, discusses her team’s findings.

news@JAMA: What got you interested in researching this question?

Dr Luo: My main interest is in smoking cessation and health outcomes. As we all know, smoking increases the risk of many diseases, including coronary artery disease, and often people gain weight after they stop smoking. So we wanted to know if that weight gain affected risk reduction negatively.

news@JAMA: And you found excessive weight gain did affect the magnitude of risk reduction.

Dr Luo: Based on our data, the majority of women gained less than 10 pounds, which basically didn’t affect the amount of risk reduction. For women without diabetes who gained more than 10 pounds, there still was a benefit in smoking cessation, but it was not as great. For women with diabetes who gained more than 10 pounds, the risk reduction was not statistically significant.

news@JAMA: What would you say to women smokers who are concerned about the weight gain associated with smoking cessation?

Dr Luo: Our message would be that they need to quit smoking, and it is never too late to quit. And even if you gain weight, the risk [for most women] is still lower than for women who continue smoking. However, an excessive amount of weight gain is less beneficial, so you need to watch your weight.



Categories: Cardiovascular Disease/Myocardial Infarction, Tobacco, Women's Health