[ProCOR] Mortality Risk of Smoking and Obesity Combined

[Researchers evaluating the effects of the two most
significant causes of preventable death worldwide determined that, contrary to what the public thinks, smoking continues to be the number one risk factor for both cancer and cardiovascular mortality. From a clinical perspective, smoking patients should be encourage to quit despite fears of gaining weight. We welcome your comments.]

Title: The Mortality Risk of Smoking and Obesity Combined

Authors: Freedman DM, et al.

Reference: American Journal of Preventive Medicine 2006; 31(5): 355-62,
http://www.ajpm-online.net/article/PIIS0749379706002789/abstract

Reviewer: Joaquin Barnoya, MD, MPH, ProCOR Contributing Editor

Purpose of study: To investigate the effects of smoking and obesity on
all-cause, cancer, and circulatory disease mortality in a cohort in the United
States.

Methods: Men (18,760) and women (64,120) completed a baseline questionnaire
(1983-1989) as part of the US Radiologic Technologists Study. Participants were
followed from the questionnaire until the date of death or through 2002,
whichever occurred first. The combined association among BMI and smoking and
mortality was examined using Cox proportional hazards regression analyses. In
the analyses, participants were grouped into four groups, men and women, older
and younger than 65 years of age.

Results: In all four gender/age groups, obesity and smoking (particularly
current smoking), increased all-cause mortality. Those <65 yrs old, normal
weight, and current smokers, posed higher mortality risks than being very obese,
never smoker. Current smokers with BMI>=35 had a 3- to 5-fold increase in
all-cause mortality compared to normal weight, never smokers. All-cause
mortality for those with BMI>=35, former smokers, was notably lower. Current
smoking was a far stronger risk factor for cancer mortality than obesity. Risk
for circulatory disease mortality was strikingly high in young men and women who
were obese and current smokers (6- to 11-fold). The only significant interaction
between smoking status and BMI was the joint effect on circulatory disease
mortality of smoking and BMI in young women.

Comment: In this nationally representative study, Freedman et al. evaluate the
detrimental effect of the two most important causes of preventable death
worldwide. Interestingly enough, and contrary to what the public thinks, smoking
continues to be the number one risk factor for both cancer and cardiovascular
mortality. From a clinical perspective, smoking patients should be encourage to
quit despite fears of gaining weight.

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