Purpose of Review

Obesity is closely linked with the pathogenesis of type 2 diabetes (T2DM) and cardiovascular disease (CVD), and whilst smoking cessation is associated with weight gain, there are concerns that this weight gain may offset the benefit of CVD risk reduction especially in those with considerable post-cessation weight gain. The aim of this narrative review is to evaluate recent evidence on smoking cessation and cardiometabolic outcomes and discuss limitations of current knowledge and studies.

Recent Findings

Nicotine is a key player in modulating energy balance by influencing lipid storage in adipose tissue by affecting lipolysis, energy input by modulating appetite and energy output by increasing sympathetic drive and thermogenesis. It also increases insulin resistance and promotes abdominal obesity. The CVD risk and mortality associated with cigarette smoking potentiate the CVD risks in patients with diabetes. Evidence supports the benefit of quitting cigarette smoking regardless of any subsequent weight gain. Data suggests that the cardiometabolic risk is limited to the first few years and that cardiovascular health and mortality benefit of smoking cessation outweighs the harm related to weight gain. This weight gain can be limited by nicotine replacement of which e-cigarettes (vaping) are increasingly popular if it is not an alternative to cigarette smoking. However, long-term health data on e-cigarettes is needed prior to formal recommendation for its use in smoking cessation.

Summary

The recommendation for cessation of cigarette smoking is justified for those at high risk of weight gain and diabetes. However, for most benefit, consideration should be given for personalized weight management to limit weight gain. Awareness of a ‘lean paradox’ by which lower weight is associated with increased CVD risk may help to improve motivation and insight into the bias of smoking, health and body composition otherwise known to epidemiologists as the ‘obesity paradox’.

中文翻译：

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戒烟后的心脏代谢发病率和死亡率，针对糖尿病和肥胖症患者的建议回顾

 审查目的

肥胖与 2 型糖尿病 (T2DM) 和心血管疾病 (CVD) 的发病机制密切相关，虽然戒烟与体重增加相关，但有人担心体重增加可能会抵消降低 CVD 风险的益处，尤其是对于那些患有戒烟后体重明显增加。本叙述性综述的目的是评估有关戒烟和心脏代谢结果的最新证据，并讨论当前知识和研究的局限性。

 最近的发现

尼古丁通过影响脂肪分解来影响脂肪组织中的脂质储存，通过调节食欲来影响能量输入，通过增加交感神经驱动和生热作用来调节能量输出，从而在调节能量平衡中发挥关键作用。它还会增加胰岛素抵抗并促进腹部肥胖。与吸烟相关的 CVD 风险和死亡率会增加糖尿病患者的 CVD 风险。有证据支持戒烟的好处，无论随后的体重增加如何。数据表明，心脏代谢风险仅限于最初几年，戒烟对心血管健康和死亡率的益处超过了与体重增加相关的危害。这种体重增加可能会受到尼古丁替代品的限制，而电子烟（电子烟）如果不能替代吸烟，则越来越受欢迎。然而，在正式建议将其用于戒烟之前，需要有关电子烟的长期健康数据。

 概括

对于那些体重增加和糖尿病高风险的人来说，戒烟的建议是合理的。然而，为了获得最大的益处，应考虑个性化体重管理以限制体重增加。认识到“瘦悖论”（即体重减轻与心血管疾病风险增加相关）可能有助于提高对吸烟、健康和身体成分偏见（流行病学家称为“肥胖悖论”）的积极性和洞察力。