Weight gain, smoking cessation, and cardiovascular risk

It is known that smoking cessation substantially reduces the risk of cardiovascular disease (CVD), but does any subsequent weight gain attenuate the benefits of quitting smoking?  The goal of this study was to answer this question in adults with and without diabetes.  Specifically, the authors tested the hypothesis that quitting smoking decreases CVD risk compared with continuing smoking, regardless of any associated weight gain.

Data collected from the Framingham Offspring Study between 1984 and 2011 were used.  At four-yearly examinations, patients were weighed and also categorised as being smokers, recent quitters (≤4 years), long-term quitters (>4 years), and nonsmokers.  The main outcome measure was the incidence over six years of total CVD events: coronary heart disease, cerebrovascular events, peripheral artery disease, and congestive heart failure.

Over a mean follow-up of 25 years, 631 CVD events occurred among 3251 participants.  Of note, the median four year weight gain was greater for recent quitters without diabetes (2.7kg) and with diabetes (3.6kg), than for long-term quitters (0.9kg and 0.0kg, respectively).  After adjustment for CVD risk factors, compared to ongoing smokers, recent quitters had a greatly reduced hazard ration (HR) for CVD of 0.47, and long-term quitters had an HR of 0.46; after further adjustment for weight change these associations showed only minimal change.


This study underlines the substantial cardiovascular benefits of quitting smoking in patients without diabetes, which were not attenuated by any subsequent weight gain.

  • Clair C, Rigotti NA, Porneala B et al.  Association of Smoking Cessation and Weight Change With Cardiovascular Disease Among Adults With and Without Diabetes.  JAMA 2013;309:1014-1021.