Not all smokers are created equal


Smoking is not good for men or women, but a new research shows that female smokers face tougher odds than male smokers after a heart attack.

Women who smoke also have heart attacks at younger ages compared to nonsmoking women who suffer heart attacks. On average, smokers are 13 years younger when admitted to the hospital, according to the University of Michigan Cardiovascular Center study.

Researchers used the University of Michigan Health System’s acute coronary event registry to examine patients’ smoking status at the time of their cardiac events. The registry contained data on 3,588 patients admitted from Jan. 1, 1999, to Dec. 31, 2006.

Among smokers, gender was a significant factor for risk of complications after a heart attack. Six months after their cardiac event, 13.5 percent of female smokers needed emergency treatment to restore blood flow compared to 4.4 percent of male smokers.

Male smokers were nine years younger than nonsmoking men when admitted for their cardiac event. By comparison, female smokers were 13 years younger than nonsmoking women.

“This is very concerning news for women,” who were already known to have an increased risk of heart attack if they smoke, as do men, says Dr. Helayne Sherman, medical director of the Women’s Healthy Heart Program at Spectrum Health, Grand Rapids, Mich. “Now this study says it happens 13 years earlier, and the complication rate is much higher.”

With other risk factors like obesity coming into play early on in life, “It’s clearly not the case that heart disease is an older woman’s disease,” adds Sherman, who was not involved in the study.

Published in the American Journal of Cardiology, the findings add to existing evidence that suggest smoking has different effects and takes a greater toll on women, says Dr. John Spangler, a family medicine professor and director of tobacco intervention programs, Wake Forest University School of Medicine, Winston-Salem, N.C.

Smoking increases the risk of breast and cervical cancer, and components in cigarette smoke cause estrogen to be metabolized into an inactive form of the hormone, which can lead to premature menopause and contribute to osteoporosis and infertility.

“There are also data showing that cigarette smoking is directly toxic to ovarian follicles from which eggs ovulate,” adds Spangler, who was not part of the study.

Researchers were not able to look at or determine the biological mechanisms that might account for gender differences, says Dr. Michael Howe, the study’s lead author and a cardiology fellow at the U-M Health System. Possible reasons might include women’s smaller coronary arteries, hormonal differences or “less aggressive medical management of women,” he says.

Smoking reduces circulation by narrowing the blood vessels and contributes to plaque building up in the arteries. Quitting smoking reduces the risk of heart disease and stroke by half in just one year, and it continues to decline until it’s as low as a nonsmoker’s risk, according to the American Heart Association.