Risk of Heart Disease 25% Higher for Women Smokers

Despite Smoking Fewer Cigarettes a Day Than Men, Women Appear to Be at Greater risk of Developing Coronary Heart Disease

Medically Reviewed by Sheena Meredith, MD on August 10, 2011
From the WebMD Archives

Aug. 10, 2011 -- Women smokers run a 25% higher risk than male smokers of developing coronary heart disease, according to a recent study. The authors of the study suggest that this increased risk for women could be due to physiological differences between the sexes.

The study, by Rachel R. Huxley, DPhil, of the division of epidemiology at the University of Minnesota, and Mark Woodward, PhD, of Johns Hopkins University in Maryland, is published in the journal The Lancet.

The authors' findings are based on an analysis of 86 previous studies involving more than 4 million people. In 75 study groups, researchers had taken account of risk factors for heart and vascular disease other than CHD itself. Among the 2.4 million participants in these studies, they found that the risk of smoking compared with not smoking was 25% higher among women than men.

Risk Increases

This increased relative risk among women was further increased by 2% for every additional year of follow-up, meaning that the longer a woman smokes, the higher her risk of developing heart disease becomes when compared with a man who has smoked for the same length of time.

The authors say: "Cigarette smoking is one of the main causes of coronaryheart disease worldwide and will remain so as populations that have so far been relatively unscathed by the smoking epidemic begin to smoke to a degree previously noted only in high-income countries. This expectation is especially true for young women in whom the popularity of smoking, particularly in some low-income and middle-income countries, might be on therise."

The actual relative risk may be even higher, say the authors. Women, on average, smoke fewer cigarettes per day than men, and in many countries the smoking epidemic in women has been much shorter in duration. Both these factors mean that the relative risk for women compared with men could actually be even higher.

Women May Take in More Carcinogens

According to the authors: "The finding that, among smokers, the excess risk of coronary heart disease in women compared with men increases by 2% for every extra year of study follow-up lends support to the idea of a pathophysiological [differing bodily responses] basis for the sex difference. For example, women might extract a greater quantity of carcinogens and other toxic agents from the samenumber of cigarettes than men. This occurrence could explain why women who smoke have double the risk of lung cancer compared with their male counterparts."

The authors conclude that doctors and health professionals should be encouraged to increasetheir efforts in promoting smoking cessation in all individuals. However, they say, "Present trends in female smoking, and this report, suggest that inclusion of a female perspective in tobacco-control policies is crucial."

Women Seen as Growth Market

In a commentary accompanying the study, Matthew A. Steliga, MD, of the University of Arkansas for Medical Sciences, and Carolyn M. Dresler, MD, MPA, of the Arkansas Department of Health's TobaccoPrevention and Cessation Program, say: "What makes the realization that women are at increased risk worrisome is that the tobacco industry views women as its growth market."

Also commenting on the findings, Ellen Mason, senior cardiac nurse at the British Heart Foundation, says: "This is very timely research as tobacco companies are increasingly targeting women with slim brands and slick packaging. Introducing plain packaging would help increase the effectiveness of health warnings and reduce the attractiveness and appeal of tobacco products."

Show Sources


The Lancet, published online Aug. 11, 2011.

News release, The Lancet.

News release, British Heart Foundation.

Office for National Statistics, 2009 General Lifestyle Study.

"Smoking, drinking and drug use among young people in England in 2010," survey carried out for the NHS Information Centre by the National Centre for Social Research and the National Foundation for Educational Research.

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