Cigarette smokers no longer have the excuse that quitting smoking would be almost as bad for their cardiovascular health as continuing to smoke, because of the weight gain often associated with smoking cessation. Results of a prospective, community-based cohort study published in JAMA indicate that, although smokers do put on weight shortly after quitting smoking, their risk of a cardiovascular disease event is approximately half that of individuals still smoking, and similar to people who were considered to be long-term quitters. The investigators suggest that “being able to quantify the association of weight gain after smoking cessation with actual cardiovascular disease risk may allow for better counselling of patients.”

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Data for 3,251 individuals from the Framingham Offspring Study were analysed. During the study period (1984–2011), smoking prevalence decreased from 31% to 13%. Among patients without diabetes mellitus, recent quitters (those who had quit smoking ≤4 years earlier) gained significantly more weight over 4 years (P <0.001) than long-term (>4 years) quitters, smokers, and nonsmokers (2.7 kg versus 0.9 kg, 0.9 kg, and 1.4 kg, respectively). Similar results were reported for patients with diabetes.

Despite the increased weight gain, the risk of a cardiovascular disease event—defined as coronary death, myocardial infarction, coronary insufficiency, angina, ischaemic stroke, haemorrhagic stroke, intermittent claudication, or congestive heart failure—over 6 years follow-up (adjusted for various cardiovascular risk factors) was about half that of smokers in recent quitters (HR 0.47, 95% CI 0.23–0.94) and long-term quitters (HR 0.46, 95% CI 0.34–0.63) amongst individuals without diabetes. As expected, nonsmokers' risk was also lower than that for smokers (HR 0.30, 95% CI 0.21–0.44). Similar trends were noted for individuals with diabetes, although the risk reductions did not reach statistical significance.

The investigators conclude that the “4-year weight gain associated with smoking cessation did not outweigh the benefits for cardiovascular disease risk associated with smoking cessation.”