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Smoking Priority: First Stop, Then Lose Weight

Smokers who are also overweight face a dilemma in trying to take care of their hearts: Should they focus first on losing weight or kicking the smoking habit?

A new study suggests stopping smoking should be the first step. All smokers had a higher risk of suffering a first heart attack than nonsmokers. But the risk didn’t significantly go up for smokers who were also obese, the study, published in the European Journal of Internal Medicine, found.

Among nonsmokers, heart-attack risk was significantly higher among obese people than those of normal weight.

Smoking and obesity are major public health problems but it hasn’t been clear whether one is more harmful than the other, the researchers said.

The relatively small effect of obesity on smoking risk underscores the effect on heart-attack risk from smoking-related changes in blood-vessel function and blood composition, the study said. Previous research has shown that gaining weight doesn’t offset the cardiovascular benefits of quitting, the study noted.

Increased heart-attack risk was also found among former smokers, the study said. However, people who stop smoking reduce their risk for heart disease within one to two years of quitting, according to the Centers for Disease Control and Prevention.

Researchers in Israel used a large health database to identify 738,380 people, age 40 to 74, whose body-mass index and smoking status were recorded in 2009 or 2010. Just over a fifth, 20.8%, were smokers, 10.7% were former smokers and 68.5% had never smoked. Of the subjects, 2,231 suffered a first heart attack in 2011.

Former smokers and smokers who weren’t obese had more than double the risk of heart attack as nonsmokers after adjusting for age, gender and socioeconomic factors. Adding obesity as a factor increased the risk among all three groups, but it was only statistically significant among nonsmokers after further adjustment for diabetes, hypertension, high cholesterol and other cardiovascular conditions, the analysis showed.

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Caveat: Certain details about former smokers’ past habits weren’t available, the researchers said. Exposure to secondhand smoke wasn’t considered.

Obesity or smoking: Which factor contributes more to the incidence of myocardial infarction?

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