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. 2024 Apr 12;24(1):1021.
doi: 10.1186/s12889-024-18468-z.

Cigarette smoking and cardiovascular disease incidence and all-cause mortality: the modifying role of diet quality

Mostafa Norouzzadeh  1 , Farshad Teymoori  1   2 , Hossein Farhadnejad  2 , Nazanin Moslehi  2 , Parvin Mirmiran  3 , Seyedeh Tayebeh Rahideh  4 , Fereidoun Azizi  5
Affiliations

Cigarette smoking and cardiovascular disease incidence and all-cause mortality: the modifying role of diet quality

Mostafa Norouzzadeh et al. BMC Public Health. .

Abstract

Background: This study examines the potential long-term joint association between smoking and diet quality as modifiable risk factors concerning cardiovascular diseases (CVDs) incidence and all-cause mortality among current and former smokers.

Methods: The study followed 955 smokers from the third and fourth examinations of the Tehran Lipid and Glucose Study to March 2018. Dietary data was collected using a food frequency questionnaire. Three diet quality indices (DQIs) were computed at baseline: DQI-international (DQI-I), DQI-revised (DQI-R), and Mediterranean-DQI (Med-DQI). Cox proportional hazards regression models were used to determine the HR (95% CI) of the joint association between smoking and diet quality among heavy and light smokers, based on the number of cigarettes per day and pack-years, as well as between current and former smokers based on smoking habits.

Results: Over a follow-up period of almost eight years, 94 cases of CVDs (9.80%) and 40 cases of mortality (4.20%) were documented. The lower diet quality based on the Med-DQI was associated with a higher risk of mortality among current smokers (HR:3.45; 95%CI:1.12, 10.57). Light smokers with good diet quality, compared to heavy smokers with poor diet quality, had a lower risk of CVDs incident (HR:0.35; 95%CI: 0.15, 0.83) and all-cause mortality (HR:0.20; 95%CI:0.05, 0.77). Current smokers with good DQI had a lower risk of mortality compared to current smokers with poor DQI (HR:0.26; 95%CI:0.08, 0.80). However, this lower risk was more significant in former smokers with good DQI (HR:0.10; 95%CI:0.02, 0.45).

Conclusions: Light and former smokers had a lower risk of developing CVDs and experiencing mortality. However, when coupled with a high-quality diet, this protective effect is even more pronounced.

Keywords: Adults; Cardiovascular diseases; Mediterranean diet; Mortality; Smoking.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of the follow-up participants
Fig. 2
Fig. 2
The Hazard ratio and 95% CI for incidence of CVDs and all-cause mortality based on the diet quality indices joint association with smoking status (Current smoker-poor DQI considered as the reference group)
See this image and copyright information in PMC

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