Smoking Is a Risk Factor of Coronary Heart Disease Through HDL-C in Chinese T2DM Patients: A Mediation Analysis

Objective: To investigate associations between smoking and cardiovascular and cerebrovascular complications in type 2 diabetes mellitus (T2DM) patients.

Methods: This is a cross-sectional study. Of 971 T2DM patients aged 14-93 years old in this study, 182 had ever smoked and 789 never smoked. Propensity score matching (PSM) reduced the confounding bias between groups. Logistic regression analysis was performed on matched data to evaluate coronary heart disease (CHD) and stroke risk. In addition, the mediation analysis was conducted among smoking exposure, HDL-C, and CHD.

Results: A total of 139 pairs of patients who had never and ever smoked were matched. Logistic regression analysis showed that compared with patients who never smoked, those who smoked > 20 cigarettes per day (CPD) had a higher risk of CHD (odds ratio [OR]: 3.09, 95% confidence interval [CI]: 1.21-7.89). Additionally, after adjusting for age, sex, origin, occupation, smoking status, body mass index, waist circumference, and diabetes duration, the OR for CHD with >20 years of cumulative smoking (pack-years) was 2.21 (95% CI: 1.05-4.65). Furthermore, we observed a significant dose-response relationship between CPD and lower high-density lipoprotein cholesterol (HDL-C) ( < 0.001). Moreover, the mediation analysis showed that the indirect effect mediated by HDL-C accounted for 86% (effect = 0.0187, 95% CI: 0.0100-0.0316).

Conclusions: Smoking may be a risk factor for CHD in T2DM patients. T2DM patients should stop smoking or reduce the CPD to prevent the onset of CHD. Moreover, to prevent CHD complications, monitoring HDL-C levels in T2DM patients who smoke may be necessary.