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Cardiac risk factors and prevention
Original research
Smoking cessation, weight gain and risk of cardiovascular disease
  1. Xiaowen Wang1,2,
  2. Jia-Yi Dong2,
  3. Renzhe Cui2,
  4. Isao Muraki2,
  5. Kokoro Shirai2,
  6. Kazumasa Yamagishi3,
  7. Yoshihiro Kokubo4,
  8. Isao Saito5,
  9. Hiroshi Yatsuya6,
  10. Norie Sawada7,
  11. Hiroyasu Iso2,3,
  12. Shoichiro Tsugane7
  13. for the Japan Public Health Center-based Prospective Study Group
  1. 1 Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
  2. 2 Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
  3. 3 Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
  4. 4 Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
  5. 5 Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Yufu, Japan
  6. 6 Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
  7. 7 Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
  1. Correspondence to Professor Hiroyasu Iso, Public Health, Osaka University Graduate School of Medicine, Osaka, Japan; iso{at}pbhel.med.osaka-u.ac.jp; Dr Jia-Yi Dong; dongjy{at}mail3.sysu.edu.cn

Abstract

Objective To examine whether the relationship between smoking cessation and risk of cardiovascular disease (CVD) was modified by weight gain.

Methods A total of 69 910 participants (29 650 men and 46 260 women) aged 45–74 years were grouped into six groups by smoking status in the first and 5-year surveys: sustained smokers, recent quitters according to postcessation weight gain (no weight gain, 0.1–5.0 kg, >5.0 kg), long-term quitters and never smokers. Quitting smoking within and longer than 5 years were defined as recent and long-term quitters, respectively. We used Cox proportional hazard models to estimate the HR for incident CVD, coronary heart disease (CHD) and stroke.

Results We identified 4023 CVDs (889 CHDs and 3217 strokes) during a median of 14.8 years of follow-up. Compared with sustained smokers, the multivariable HR (95% CI) for CVD was 0.66 (0.52 to 0.83) for recent quitters without weight gain, 0.71 (0.55 to 0.90) for recent quitters with weight gain of 0.1–5.0 kg, 0.70 (0.44 to 1.10) for recent quitters with weight gain of >5.0 kg, 0.56 (0.49 to 0.64) for long-term quitters, and 0.60 (0.55 to 0.66) for never smokers. The analysis restricted to men showed a similar association. Prespecified analysis by age suggested that recent quitters overall had a lower HR for CVD among those aged <60 years vs ≥60 years. Similar patterns of association were observed in CHD and stroke.

Conclusions Postcessation weight gain did not attenuate the protective association between smoking cessation and risk of CVD.

  • epidemiology
  • smoking
  • stroke
  • coronary artery disease

Data availability statement

Data are available upon reasonable request. Japan Public Health Center-based Prospective Study (JPHC study) data and/or biospecimens can be accessed at Epidemiology and Prevention Division, Research Center Cancer Prevention and Screening, National Cancer Center (epi.ncc.go.jp/en/jphc/805/8155.html).

https://doi.org/10.1136/heartjnl-2021-318972

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    Data availability statement

    Data are available upon reasonable request. Japan Public Health Center-based Prospective Study (JPHC study) data and/or biospecimens can be accessed at Epidemiology and Prevention Division, Research Center Cancer Prevention and Screening, National Cancer Center (epi.ncc.go.jp/en/jphc/805/8155.html).

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    Footnotes

    • Contributors XW and J-YD designed the study and analysed the data. XW drafted the manuscript. All authors conducted the technique review and edited the manuscript. J-YD is the guarantor of this work and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This study was supported by the National Cancer Center Research and Development Fund (23-A-31(toku), 26-A-2, 29-A-4, 2020-J-4) (since 2011) and a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare of Japan (from 1989 to 2010).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.