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SMOKING AND RISK OF CORONARY HEART DISEASE AMONG WOMEN WITH TYPE 2 DIABETES MELLITUS-A PROSPECTIVE STUDY AT TERTIARY CARE HOSPITAL FROM NORTH INDIA
Premshanker Singh*, Mridu Singh and Ritu Karoli
Although the association between smoking and increased risk of coronary heart disease (CHD) is well established in the general population but this relationship is less well-defined among individuals with diabetes.In this study,we aimed to assess the relationship between cigarette smoking and risk of CHD among women with type 2 diabetes mellitus. All women diabetics reporting to Medicine dept of Dr Dr RML Institute of Medical Sciences, Lucknow, India for their treatment were included in this study. There were total of 1637 women diagnosed as having type 2 diabetes mellitus. All these diabetic women were assessed for CHD as main cardiac outcome in this study. We documented 115 incident cases of CHD (50 fatal CHD-related cases and 65 nonfatal myocardial infarctions). We found a dose-response relationship between current smoking status and risk of CHD among diabetic women. Compared with never smokers, the relative risks (RRs) for CHD were 1.21 (95% confidence interval [CI], 0.97-1.51) for past smokers, 1.66 (95% CI, 1.10-2.52) for current smokers of 1 to 14 cigarettes per day, and 2.68 (95% CI, 2.07-3.48) for current smokers of 15 or more cigarettes per day in multivariate analyses (P<.001 for trend). The multivariate RR of CHD among diabetic women who had stopped smoking for more than 2 years was similar to that among diabetic women who were never smokers (RR, 1.01; 95% CI, 0.73-1.38). In secondary analyses involving diabetic and nondiabetic women, the multivariate-adjusted RR of CHD for those with diabetes who currently smoked (?15 cigarettes per day) compared with those who never smoked was 7.67 (95% CI, 5.88-10.01).Cigarette smoking is strongly associated with an increased risk of CHD among women with type 2 diabetes mellitus. Furthermore, quitting smoking seems to decrease this excess risk substantially; women with diabetes should be strongly advised against smoking. Diabetes confers a substantially increased risk of coronary heart disease (CHD).[1,2,3] especially among women.[4,5] Smoking is an established risk factor for CHD among the general population.[6,7] However, the magnitude of the association between smoking and CHD risk among diabetic women has not been well studied.[7,8] Furthermore, the impact of quitting smoking, using quantitative measures of quitting history, on this CHD risk has not been investigated fully. Therefore, we assessed the relationships of smoking and quitting smoking to the risk of CHD among diabetic women.[Full Text Article]