Are Young Female Smokers at Greater Risk For STEMI?

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Smoking increases both men's and women's risk of acute ST segment elevation myocardial infarction (STEMI) at all ages, but women smokers have a significantly higher increased risk compared to men, especially women under 50 years old, according to a study published June 24 in the Journal of the American College of Cardiology. Despite the increased risk, smokers can reduce their risk to that of a never smoker in as little as a month after quitting.

James Palmer, BMEDSCI, MBCHB, et al., sought to assess smoking as an independent risk factor for STEMI and determine the differences in risk between age groups and genders. They used a retrospective ecological cohort study to compile data for all patients in the South Yorkshire region of the U.K. who presented with acute STEMI between January 2009 and July 2014, which included 3,343 STEMIs. The percentage who were current smokers was similar between genders, with 46.8 percent of female patients and 47.6 percent of male patients.

They found that smoking increases STEMI risk in all patients, regardless of age or gender; however, the risk is higher in females compared to males at all ages. The largest relative risk difference between men and women smokers was in the 50-64 years old group, but the highest risk increase in both genders was in the 18-49 years group – the youngest group. Female smokers in this age group had a greater than 13 times higher risk of STEMI compared to their non-smoking female contemporaries. Young male smokers had an 8.6 times increased risk.

The authors suggested several possible reasons why smoking leads to such a greater risk of STEMI for females, including that smoking may lower levels of serum estrogen, which has been determined to have protective effects against atherosclerosis. Also, men have been found to have larger coronary arteries than women, meaning that chronic inflammation from smoking may lead to a greater degree of arterial narrowing in women than men since their arteries are narrower to begin with. Several other vascular conditions are more prevalent in female STEMI patients, including vasospasm, vasculitis and spontaneous coronary artery dissection.

The researchers said it is highly likely that smoking perpetuates some of these events and imposes a greater increase in STEMI risk for women. Researchers also speculated that since a previous study had shown that physicians perceived coronary artery disease in males as being more important than in females, professional advice on smoking cessation may differ between genders if smoking is considered to be less of a cardiac risk for females.

However, researchers also found it is possible to substantially reverse the risk by quitting smoking.

"Our study found that smoking cessation, regardless of age or gender, reduces STEMI risk to that of a never smoker, possibly within a month," said Ever Grech, MD, FACC, senior author of the study. "Patients who smoke merit encouragement to give up their habit, and this study adds quantitative evidence to the massive benefits of doing so."

In a related editorial comment, Eric C. Stecker, MD, FACC, and Thomas A. Dewland, MD, explain that, "The work of Palmer et al., underscores the important role that smoking plays in the morbidity and mortality of every cardiologist's patients, and it reminds us of the great impact we can have if we approach our task with constancy and purpose."

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Smoking

Keywords: Coronary Artery Disease, Smoking Cessation, Myocardial Infarction, Risk Factors, Retrospective Studies, Smoking, Coronary Vessel Anomalies, Atherosclerosis, Vasculitis, Inflammation, Estrogens


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