Women smokers face tougher odds than men after heart attack

Women who smoke have heart attacks at younger ages and are more likely than men to suffer complications months after a cardiac event, according to a new University of Michigan Cardiovascular Center study.

Although fewer women than men smoke in the United States, the gender gap is decreasing and the U-M findings suggest the toll of smoking is greater on women’s health.

“Smoking is not good for men or women but our analysis shows that women who smoke do worse six months after a heart attack than men,” says senior study author Elizabeth Jackson, MD, cardiologist at the U-M Cardiovascular Center. “We were not able to look at the basic biological mechanisms that would account for this, but other studies can give us some ideas.

“The ideologies of acute coronary syndrome may be different and the atherosclerotic burden greater for women,” Jackson says.

Smoking reduces circulation by narrowing the blood vessels and contributes to an atherosclerotic build-up of plaque in the arteries. Cigarette smokers are two to four times more likely to develop heart disease than non-smokers.

Jackson and lead author Michael Howe, MD, a cardiology fellow at the U-M Health System, conducted a study to examine smoking status of patients during and six months after an acute coronary syndrome event, such as a heart attack.

They used the U-M Health System’s acute coronary event registry which has data on 3,588 patients admitted to the U-M Medical Center from Jan. 1, 1999 to Dec. 31, 2006 with a diagnosis of ACS.  

A reported 24 per cent of patients were actively smoking. Male smokers were nine years younger than non-smoking men when admitted for their cardiac event. Women smokers were 13 years younger than non-smoking women when admitted.

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 of male smokers who needed an unscheduled revascularization.

“The differences in outcomes among women smokers may reflect inherent biological differences between genders, or possibly less aggressive medical management of women that’s been described by other investigators,” Howe says. “Either way, it clearly emphasizes the need for increased physician awareness and vigilance, in women in particular, after an acute coronary event.”

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