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The 13th World Conference on Tobacco OR Health

Building capacity for a tobacco-free world

July 12-15, 2006, Washington, DC, USA

Thursday, July 13, 2006 - 2:45 PM

A paradigm shift in managing smoking patients: Developing “Glucose Equivalent” and “Blood Pressure Equivalent” concept resulting from exploring their mortality relationships

Chi Pang Wen, MD, DrPH1, Ting Yuan David Cheng, MS2, Hui-Ting Chan, MS3, Hui-Ling Hsu, MS1, Shan Pou Tsai, PhD4, and Shon Yu1. (1) Health Policy Division, National Health Research Institutes, Taiwan, 35 Keyan Rd., Zhunan Town, Maioli County, Taiwan, (2) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21215, (3) Division of Health Policy Research, National Health Research Institutes, Taiwan, 35 Keyan Rd., Zhunan Town, Maioli County, Taiwan, (4) School of Public Health, University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030

Objective: The extent of interaction between smoking and diabetes or smoking and hypertension has been under-appreciated. Patients seen in the office are usually more interested in reducing blood sugar or blood pressure than in quitting smoking, and yet, smoking caused mortality risks at a magnitude more than either diabetes or hypertension, the primary reason for seeking medical care. The concept of “Glucose Equivalent” or “Blood Pressure Equivalent” of smoking was developed to direct attention to smoking during encounters in clinical settings.

Methods: Anthropometric and blood pressure were measured, blood samples collected from 23,755 study subjects between 1989 and 1992, and vital status ascertained as of December 31, 2001. Cox proportional hazard model was used to estimate the adjusted mortality risk by levels of glucose and blood pressure. Equivalent clinical values calculated from individually fitted lines.

Results: Based on a follow up observation on a large Asian cohort, the all-cause mortality risk of an individual who smokes was found to be equivalent to an elevation of blood glucose of 68 mg/dl in the diabetes patients or an elevation of 63 mmHg in the hypertensive patients.

Conclusion: Direct clinical management of these problems in order to achieve such a magnitude of improvement is extremely difficult and, even if achieved, can rarely be sustained. Through smoking cessation, they can be achieved on a permanent basis. Appreciating this concept has the potential of paradigm shift in clinical management of these smoking patients and can bridge the disconnect between smoking and diseases.