• Posted November 13, 2023

Prediabetes Plus Smoking a Deadly Combo for Young Adults

Young people who smoke and have prediabetes have triple the risk of suffering a stroke, a new study shows.

Overall, hospitalized tobacco users with prediabetes had a 3.3 times higher risk that they were in the hospital due to a stroke, after researchers accounted for other risk factors.

The findings “warrant early screening and prevention strategies for prediabetes in young tobacco users in order to curtail their risk of stroke,” said lead researcher Dr. Advait Vasavada, a resident in family medicine at the University of Nebraska Medical Center in Omaha.

Vasavada plans to present the findings at the American Heart Association (AHA) annual meeting, being held from Nov. 11-13 in Philadelphia. Findings presented at a medical meeting should be considered preliminary until published in a peer-reviewed journal.

For the study, Vasavada's research team analyzed records for more than 1 million tobacco users ages 18 to 44 who were admitted to a U.S. hospital in 2019.

All the young adults included in the study were considered healthy, with no heart disease risk factors like high blood pressure, type 2 diabetes, elevated cholesterol or obesity.

However, their charts showed that all were long-term tobacco users who were dependent on nicotine and had a hard time cutting back or quitting.

Looking more closely, researchers found that about two out of every 1,000 also had prediabetes -- elevated blood sugar levels that put a person at increased risk of developing type 2 diabetes.

Comparing hospitalized smokers with prediabetes to those without prediabetes, researchers found:

• Higher rates of chronic obstructive pulmonary disease (COPD) (19% vs 12%), previous heart attack (1.5% vs 0.4%) and kidney disease (2.5% vs 0.9%)

• A higher chance they were hospitalized due to heart attack, stroke or heart failure (2.9% vs 1.4%)

• An increased chance that the hospitalization was specifically due to a stroke (1.9% vs 0.5%)

“If you're a metabolically healthy, young adult dependent on tobacco use, it is wise to cut down on but better yet eliminate tobacco use completely,” Vasavada said in an AHA news release. “It is also worth noting that having prediabetes can significantly increase your risk of having a stroke at a young age, even if you don't use tobacco products.”

The results show why tobacco use is dangerous even for young adults, said Dr. Esa Davis, a member of the American Heart Associations' Drug, Alcohol and Tobacco Committee.

“Young people are usually under the impression that stroke occurs in older individuals -- their grandparents' age. But we're starting to see evidence, such as in this study, that's not the case, strokes are occurring at younger ages,” Davis said.

“The single most important thing you can do for your heart health and to decrease your risk of stroke and heart disease is to quit smoking,” Davis added. “And with this study, it indicates that if you have prediabetes, it's even more important for you to quit smoking as soon as you can, because your risk of stroke and heart disease becomes much higher and can occur much sooner.”

More information

Johns Hopkins has more about prediabetes.

SOURCE: American Heart Association, news release, Nov. 6, 2023