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Female smokers at greater risk after a heart attack than other patients

Women who smoke and have had an acute coronary syndrome event should be closely monitored, because they are more likely to develop subsequent cardiovascular problems than other patients.

A study published online Sept. 19 in The American Journal of Cardiology found that 55% of female smokers experienced at least one cardiovascular problem within six months of having an acute coronary incident compared with half of nonsmoking women. The figure was 42% for nonsmoking males and 33% for male smokers (

“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,” said senior study author Elizabeth Jackson, MD, MPH, a cardiologist at the University of Michigan Cardiovascular Center.

She recommends that primary care physicians “be aggressive about secondary prevention in female smokers [by] treating them with evidence-based medication such as aspirin and statins.”

Dr. Jackson said secondary prevention also should include helping patients quit smoking. “At every visit, they should ask patients if they’re contemplating quitting and then get them the tools to help them quit.”

An estimated 46 million U.S. adults (21% of the adult population) smoke cigarettes, according to the Centers for Disease Control and Prevention. The habit accounts for nearly one in five deaths in the U.S. each year. Smokers are up to four times more likely to develop coronary heart disease than nonsmokers, the CDC said.

Researchers assessed data on 3,588 patients 18 and older admitted to the University of Michigan Health System for an acute coronary syndrome event between Jan. 1, 1999, and Dec. 31, 2006. Patients were categorized as smokers or nonsmokers, which included people who quit the habit and those who never smoked. Twenty-four percent of patients reported smoking when they were hospitalized

Among men admitted for a cardiac event, smokers were an average age of 55 — more than nine years younger than nonsmoking men. The average age of hospitalized female smokers was 56, more than 13 years younger than women who did not smoke.

The medical community once thought that because smokers often are young when they have their first cardiac event, they have fewer subsequent cardiovascular problems than nonsmokers, said Dr. Jackson, an assistant professor of medicine at the University of Michigan Health System. “That’s the case for men who smoke, but not for women,” she said.

Dr. Jackson said the different outcomes among male and female smokers could reflect inherent biological differences between the genders. She said the disparity also could be due to the less aggressive medical management women often receive after a cardiovascular incident.

“Either way, the [study] clearly emphasizes the need for increased physician awareness and vigilance — in women in particular — after an acute coronary event,” Dr. Jackson said.

Copyright 2011 American Medical Association. All rights reserved.

Female smokers at greater risk after a heart attack than other patients