American Heart Association Scientific Sessions 2023, summary poster Su4248
Research Highlights:
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"These findings from a large-scale US study justify early screening and prevention strategies for prediabetes in young tobacco users to reduce their risk of stroke," said study author Advait Vasavada. , MBBS, Family Medicine resident at the University of Nebraska Medical Center in Omaha.
Researchers used the National Inpatient Sample, a large national database, to analyze hospital admissions across the United States in 2019 of more than 1 million young tobacco users (ages 18 to 44). All were considered metabolically healthy and had no known cardiovascular disease risk factors, such as high blood pressure, type 2 diabetes, high cholesterol or obesity. All had a diagnosis noted in their medical records as persistent or long-term nicotine-dependent tobacco users and had difficulty reducing the amount they used.
Of those admitted to hospital, approximately two in every 1,000 had prediabetes and were tobacco dependent. Prediabetes refers to a fasting blood sugar level that is higher than normal and can progress to a diagnosis of type 2 diabetes. People with prediabetes also have an increased risk of heart disease and stroke. ; However, these risks can be reduced through lifestyle changes, such as eating healthy foods, losing weight, and increasing physical activity.
By comparing hospitalized tobacco users with prediabetes to those without prediabetes, researchers determined the following:
- Higher rates of obstructive pulmonary disease (19.2% vs. 11.7%, respectively), previous heart attack (1.5% vs. 0.4%, respectively), and chronic kidney disease (2.5% vs. 0.9%, respectively).
- A greater likelihood that hospitalization was due to a heart attack, stroke, or heart failure (2.9% vs. 1.4%, respectively).
- A greater likelihood that hospitalization was due to a stroke (1.9% vs. 0.5%, respectively).
After adjusting for numerous possible factors that could also have played a role (such as age, race, sex, household income, alcohol or drug abuse, and some other medical conditions), tobacco users hospitalized with prediabetes had a 3.31 times greater risk of hospitalization due to stroke.
“If you are a young adult who is metabolically healthy and dependent on tobacco, it is advisable to reduce it, although it would be even better to eliminate it completely. It’s also worth noting that having prediabetes can significantly increase your risk of having a stroke at a young age, even if you don’t use tobacco products,” Vasavada said. “It is advisable to develop an overall healthy lifestyle, as well as making sure your blood sugar level is well controlled and measured at your routine preventive care visits.”
Esa M. Davis, MD, MPH, a member of the American Heart Association’s Committee on Drugs, Alcohol and Tobacco, said the study results provide additional evidence of why tobacco use is dangerous and that quitting smoking is essential to prevent heart disease and stroke.
“Having prediabetes alone already represents an important risk factor for developing cardiovascular diseases,” he said. “When you add tobacco use, this dramatically increases the risk of having a stroke and therefore it is more important to make an effort to stop using tobacco.”
Davis is Professor of Family and Community Medicine and Senior Associate Dean of Community and Population Health Medicine at the University of Maryland School of Medicine in Baltimore.
“Young people often have the impression that strokes happen to older people; that is, at the age of their grandparents. However, we are starting to have evidence, as in this study, that this is not the case, since strokes occur at younger ages,” he stated.
“The most important thing you can do for your heart health and to lower your risk of stroke and heart disease is to quit smoking. And, with this study, it indicates that if you have prediabetes, it is even more important that you stop smoking as soon as possible, because your risk of stroke and heart disease becomes much higher and can occur much sooner.”
Background of the study:
The study consisted of an analysis of electronic medical records from the 2019 National Inpatient Sample. The database records between 7 and 8 million hospital admissions each year.
Overall, both groups consisted primarily of white adults; however, the non-prediabetes group had more white adults (67.9% vs. 45.7%, respectively). The prediabetes group had a higher percentage of black adults compared to the non-prediabetes group (33.8% vs. 17.7%, respectively).
The median age of people with prediabetes was 36 years.
In this study, among hospitalized young tobacco users, those with prediabetes were older (median age 36 vs. 31 years, respectively) and, more often, men.
Of 1,017,540 hospitalized young tobacco users, 2,390 (0.2%) people had higher than normal blood sugar levels, meeting the criteria for prediabetes.
The analysis included all forms of tobacco use; however, no additional information was available to categorize the type of use.
The study had several limitations, including that it examined patient data from hospital records; used a database that may include coding errors; information on the exact reason for each hospitalization was missing; and there was no follow-up data. While the researchers were able to consider and adjust for numerous factors that could have influenced stroke risk, there may have been unrecognized factors that were overlooked or not included.
“We only had information on the rates of stroke and other cardiac events associated with a single hospitalization. "Prospective studies would be warranted to observe the rate of stroke over time in young tobacco users with and without prediabetes," he said.
