Blog | Monday, March 18, 2013

QD: News Every Day--What to tell patients when they gain weight while quitting smoking

Physicians can tell their patients that any weight gained while quitting smoking still results in a net cardiovascular benefit, a study found.

Quitting smoking, compared with continuing smoking, was associated with a lower risk of cardiovascular disease despite subsequent weight gain, the authors reported.

Weight gain is justifiable as one of smokers' major concerns, study authors wrote, since the average gain varies between 6.6 lbs. and 13.2 lbs. within 6 months after quitting smoking, and persists over time.

To assess the association between 4-year weight gain following smoking cessation and cardiovascular disease among adults with and without diabetes, researchers reviewed data from the Framingham Offspring Study collected from 1984 through 2011. At each 4-year examination, self-reported smoking status was assessed and categorized as smoker, recent quitter (4 years or less), long-term quitter (more than 4 years), and nonsmoker.

Results appeared in the March 13 issue of JAMA.

Among participants without diabetes, recent quitters gained significantly more weight (median [midpoint], 5.9 lbs.) than long-term quitters (1.9 lbs.), smokers (1.9 lbs.), and nonsmokers (3 lbs.). Among patients with diabetes, recent quitters also gained significantly more weight (7.9 lbs.) than smokers (1.9 lbs.), long-term quitters (0.0 lbs., and nonsmokers (1.1 lbs.).

After an average follow-up of 25 years, 631 cardiovascular events occurred among 3,251 participants. Among nondiabetics, age- and sex-adjusted cardiovascular disease incidence rates were lower for nonsmokers, recent quitters, and long-term quitters, compared with smokers.

After adjusting for cardiovascular disease risk factors, compared with smokers, recent quitters had a 53% lower risk for cardiovascular disease and long-term quitters had a 54% lower risk for cardiovascular disease with only a minimal change after further adjustment for weight change.

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

"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," the authors wrote. "This supports a net cardiovascular benefit of smoking cessation, despite subsequent weight gain," the authors write.

In an accompanying editorial, authors suggested, that physicians can reassure their patients that weight gain is no reason not to try to stop smoking.

"About 50% of female smokers and about 25% of male smokers are 'weight concerned,' which may discourage quit attempts and quitting success," they wrote. "Although such reassurance may not assuage concerns about the effects of weight gain on appearance, it may nevertheless be helpful. Furthermore, even though no treatments have been shown to reliably prevent cessation-related weight gain, exercise regimens may be beneficial, and use of nicotine replacement medications can suppress weight gain during their use. Second, physicians should use this information to reinforce their commitment to provide or arrange evidence based treatment for all of their patients who smoke."