[Active smoking: A major risk factor for human non-communicable diseases in a hospital survey]

Ten-Year Cardiovascular Risk as Predicted by the QRISK®3 Calculator in Diabetic Patients Attending a Tertiary Care Teaching Hospital in Central India and Its Application to Stratify Statin Over-Users and Under-Users

BACKGROUND

Cardiovascular disease (CVD) is an important cause of morbidity and mortality in diabetic patients. As such, risk stratification is essential to identify the risk factors of CVD and provide early intervention. The QRISK®3 tool, recommended by the National Institute for Health and Care Excellence (NICE) guidelines, has the option to choose the patient's ethnicity, which is not available in other tools. However, there is a paucity of data regarding the use of this tool in the Indian population. Therefore, this study was planned to predict 10-year CVD risk using the QRISK®3 tool and to determine statin eligibility in diabetic patients.

METHODS

We enrolled diabetic patients visiting our general medicine outpatient department and diabetic clinic in the study. We collected data from clinical and prescription records, as well as through patient interviews. We analyzed the data to determine the 10-year CVD risk using the QRISK®3 risk tool, which is available online. A cut-off QRISK score of 10%, as recommended by the NICE guidelines (2014), was used to stratify patients as "over-users" and "under-users." We also analyzed the data to determine any correlation between other risk factors and QRISK scores.

RESULTS

Of the 134 diabetic patients recruited in this study, 43 (32.09%) had a CVD risk score of <10%, of which 16 (37.21%) were categorized as "over-users." Of the patients, 91 had a CVD risk score of ≥10%, of which 17 (18.68%) were categorized as "under-users." Risk factors showing a positive correlation with QRISK score included duration of diabetes, age, blood pressure treatment, waist circumference, and non-high-density lipoprotein cholesterol level.

CONCLUSION

QRISK score can be useful to predict 10-year CVD risk in the Indian population and to stratify patients as statin over-users and under-users. This tool can be used in the Indian set-up to identify potential candidates for statin initiation.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): The case for Tunisia

INTRODUCTION

The World Health Organization (WHO) had launched the Framework convention on Tobacco Control (FCTC) in 2003 in order to curve the epidemic of tobacco use worldwide. Since most smokers begin to smoke before the age of 18 years, Global Youth Tobacco Survey (GYTS) has been developed in order to monitor tobacco smoking among adolescents. Our aim was to assess smoking among Tunisian youth using GYTS 2017 data.

METHODS

GYTS is cross-sectional, two cluster school-based survey to produce a representative sample of students aged 13-15 years. It was conducted in 2017 in 67 secondary schools in Tunisia. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics.

RESULTS

Lifetime cigarettes and waterpipe prevalence were 7.8% (14.4% of boys, 1.6% of girls, p<0.001) and 7.2% (13% of boys, 2.8% of girls, p<0.001), respectively. Among cigarette smokers, 62.5% were able to buy their own cigarettes. Overall, 23.5% of cigarette smokers and 41.5% of waterpipe smokers were not able to buy their products because of their age. Sixty percent of smokers wanted to quit and 56.4% had already tried to stop. Half of the respondents were exposed to SHS in their homes and 62.1% in indoor public places.

CONCLUSIONS

In Tunisia, tobacco prevalence among youth is high. Youth have free access to tobacco products and smoke-free regulations are only partially respected.

Cigarette Smoking Is Negatively Associated with the Prevalence of Type 2 Diabetes in Middle-Aged Men with Normal Weight but Positively Associated with Stroke in Men

BACKGROUND

The prevalence of diabetes and potentially related complications, including stroke, is rapidly increasing in China. The long-term effects of lifestyle may affect glucose metabolism in the general population. Although some studies have shown an association between smoking and the risk of type 2 diabetes mellitus (T2DM), the relationship remains unclear. Furthermore, the relationship between smoking and stroke in patients with T2DM has not been fully elucidated.

OBJECTIVE

We investigated the influence of cigarette smoking on T2DM and stroke in China. Detailed questionnaires about smoking status and anthropometric measurement were completed by participants, and oral glucose tolerance testing (OGTT), hemoglobin A1c (HbA1c), homeostasis model assessment of IR (HOMA-IR), and blood lipids were measured.

RESULTS

In total, 8196 adults aged 40 years or older were included. We found a reduced risk of impaired glucose regulation (IGR) and T2DM in male smokers with normal weight (body mass index (BMI) < 25 kg/m² or waist circumference (WC) < 90 cm) compared with nonsmokers after adjusting for age, alcohol intake, physical activity, educational level, family history of diabetes, SBP, DBP, TG, TC, HDL-C, and LDL-C. However, no significant association was detected in male current smokers with overweight/obesity or female smokers. In addition, compared with nonsmokers without T2DM, current smokers with T2DM had a significantly higher risk of stroke (odds ratio: 2.64, 95% confidence interval: 1.25-5.57; P = 0.011) after adjusting for confounders.

CONCLUSIONS

Smoking was negatively associated with T2DM in Chinese men of normal body weight, but no significant association was found for men with overweight/obesity or women. In addition, smoking was positively associated with nonfatal stroke, especially in patients with T2DM. Further prospective studies are needed to examine the association between smoking, diabetes, and stroke in different ethnic groups.