Just like anyone in the general population, when individuals with severe mental illness try to quit smoking, they tend to gain weight. However, since this already vulnerable group tends to have a higher risk of cardiovascular disease, do the benefits of quitting smoking outweigh the cardiovascular risks associated with weight gain?
Yes, at least in the first year, say researchers at Massachusetts General Hospital (MGH). But if the weight gain continues, the risk goes back up.
People with serious mental illness have a much shorter life expectancy — up to 25 years less than the general population — primarily due to a greater risk of cardiovascular disease. Both obesity and smoking are at least twice as high among adults with mental illness. They also have a greater risk of developing hypertension, diabetes, and elevated cholesterol levels.
“These findings highlight the importance of smoking cessation among this vulnerable population,” says Anne Thorndike, M.D., MPH, of the MGH Department of Medicine, lead and corresponding author of the report.
“But they also indicate that continued weight gain associated with tobacco cessation is likely to contribute to a rise in the already high rates of obesity, diabetes, and hypertension among people with serious mental illness.”
Thorndike adds, “Evaluating programs that address multiple health behaviors among adults with serious mental illness will be important. Group-based smoking cessation programs that also incorporate diet and exercise interventions may be more successful for reducing cardiovascular risk than programs that address one behavior at a time.”
The researchers of the current study note that most smoking cessation trials have excluded patients with serious mental illness, leaving open the question of whether they would share the benefits found in the general population.
The researchers analyzed a subgroup of 65 smokers with serious mental illness who were already participating in a clinical trial of the drug varenicline (Chantix). They examined the differences in weight gain and other risk factors between 33 participants who remained abstinent during the 40-week follow-up period and 32 participants who resumed smoking.
The findings showed no significant differences in weight between groups after the 12-week cessation period. At the end of the follow-up period, however, those who continued to be tobacco-free had a greater average weight gain — about 10 pounds compared with around 2.5 pounds — than did those who resumed smoking.
Still, the Framingham Risk Score, which estimates the risk of developing cardiovascular disease in the next 10 years, remained lower for the abstinent group than for those who relapsed, an improvement based entirely on smoking cessation.
However, weight gain among abstinent participants continued during the entire follow-up period and was accompanied by greater increases in blood sugar levels than among those who began smoking again.
These findings suggest that, even after quitting, those with serious mental illness will continue to be at higher risk for cardiovascular disease because of higher rates of diabetes, hypertension, and elevated cholesterol due to worsening obesity.
“Smoking cessation needs to be a priority for adults with serious mental illness, and there is now good evidence to support using cessation medications such as varenicline and nicotine replacement to help these patients,” says Eden Evins, M.D., MPH, director of the MGH Center for Addiction Medicine. “However, it will be important in the future to address behavioral and medical health in a more integrated fashion.”
The findings are published online in the Journal of Clinical Psychiatry.