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Relationship of Cardiorenal Risk Factors with the Progression of Albuminuria in Ex-Smokers Based on Age, Glycaemic Status, and BMI: A Cohort Study of the UK Biobank Data
36 Pages Posted: 20 Mar 2023
More...Abstract
Background: Smoking cessation is recommended to prevent vascular complications. Post-cessation weight gain and a rise in glycosylated haemoglobin (HbA1c) are significant barriers to successful quitting. This cohort study examines the relationship of cardiorenal risk factors and progression of albuminuria at two-time points.
Methods: From the follow-up visits of the UK Biobank study, 2805 participants were selected who had their urinary albumin concentration (UAC) recorded in the first and second visits. Logistic regression models were fitted to explore the relationship between cardiorenal risk factors and the progression of albuminuria, where progression was defined as an increase in UAC between the visits. Results are expressed in odds ratio (OR) and 95% confidence intervals (CI).
Findings: At the time-point of the second visit, compared to other age groups, albuminuria was significantly more prevalent in smokers who started smoking between the ages of 13 and 19 and quit between 25 to 35. With a mean follow-up period of 51 months, after adjusting for confounding variables of age, sex, cholesterol, high-density lipoprotein (HDL), creatinine, body mass index (BMI), smoking status and change in HbA1c between the first and second visits, statistically significant predictors of progression of albuminuria were age and HbA1c, OR 1.20 (1.06 to 1.36) and 1.03 (1.00 to 1.05), respectively. In ex-smokers, statistically significant predictors of progression were age OR 1.09 (1.02 to 1.16) and years of smoking before quitting OR 1.04 (1.00 to 1.09). The predictor of regression was years of abstinence OR 0.94 (0.90 to 0.99). BMI and waist circumference were not statistically significant predictors of progression of albuminuria.
Interpretation: Preventing children from taking up the habit of smoking at an early age, quitting smoking before the age of 25, and remaining abstinent long-term may reduce the risk of progression of albuminuria. Smokers should be reassured that post-cessation weight gain without a rise in HbA1c is unlikely to cause progression of albuminuria.Funding There was no external funding for this study. The University of Sheffield paid the open-access publication charge.
Funding: The publication cost for this study was funded by the University of Sheffield.
Declaration of Interest: DK, AE, MN, PB, MS, KJ, AL and EG reports no conflicts of interest. SdeL reports that through his university, he has had grants not directly relating to this work from AstraZeneca, GSK, Sanofi and Seqirus, and Takada for vaccine research and membership of advisory boards for AstraZeneca, Sanofi and Seqirus. KK is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre (BRC). KK was a consultant and speaker for Amgen, AstraZeneca, Bayer, Novartis, Novo Nordisk, Roche, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from AstraZeneca, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. KK has received funds for research and honoraria for speaking at meetings and has served on advisory boards for AstraZeneca, Lilly, Sanofi-cool Aventis, Merck Sharp & Dohme, and Novo Nordisk. MJD reports grants from AstraZeneca, Boehringer Ingelheim, Sanofi, Novo Nordisk, and Janssen; consulting fees from Novo Nordisk, Eli Lilly, Sanofi, and Boehringer Ingelheim; payments from Novo Nordisk, Eli Lilly, AstraZeneca, Sanofi, Boehringer and Ingelheim, and participation on advisory board for Novo Nordisk, Eli Lilly, AstraZeneca, Janssen, Sanofi, and Boehringer Ingelheim.
Ethical Approval: UK Biobank received ethics approval from the Northwest Multi-centre Research Ethics Committee (MREC) and from the National Information Governance Board for Health & Social Care (NIGB). For this study, a separate ethics approval was obtained from the University of Sheffield Research Ethics Committee (Application Number 038586, 09/03/2021).
Keywords: Smoking, albuminuria, type 2 diabetes mellitus
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