Zorana Vasiljevic1, Marialuisa Scarpone2, Maria Bergami2, Jinsung Yoon3, Mihaela van der Schaar4, Gordana Krljanac5, Milika Asanin5, Goran Davidovic6, Stefan Simovic6, Olivia Manfrini2, Natasa Mickovski-Katalina7, Lina Badimon8, Edina Cenko2, Raffaele Bugiardini9. 1. Medical Faculty, University of Belgrade, Belgrade, Serbia. 2. Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. 3. Google Cloud AI, Sunnyvale, CA, USA; Department of Electrical and Computer Engineering, University of California, Los Angeles, USA. 4. Department of Electrical and Computer Engineering, University of California, Los Angeles, USA; Cambridge Centre for Artificial Intelligence in Medicine, Department of Applied Mathematics and Theoretical Physics and Department of Population Health, University of Cambridge, Cambridge, United Kingdom. 5. Cardiology Department, Clinical Centre of Serbia, Medical Faculty, University of Belgrade, Serbia. 6. Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia. 7. Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Center for Prevention and Control of Diseases, Department for Prevention and Control of Non-communicable Disease, Belgrade, Serbia. 8. Cardiovascular Research Program ICCC, IR-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, Barcelona, Spain. 9. Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. Electronic address: raffaele.bugiardini@unibo.it.
Abstract
BACKGROUND AND AIMS: An increasing proportion of women believe that smoking few cigarettes daily substantially reduces their risk of developing cardiovascular (CV) related disorders. The effect of low intensity smoking is still largely understudied. We investigated the relation among sex, age, cigarette smoking and ST segment elevation myocardial infarction (STEMI) as initial manifestation of CV disease. METHODS: We analyzed data of 50,713 acute coronary syndrome patients with no prior manifestation of CV disease from the ISACS-Archives (NCT04008173) registry. We compared the rates of STEMI in current smokers (n = 11,530) versus nonsmokers (n = 39,183). RESULTS: In the young middle age group (<60 years), there was evidence of a more harmful effect in women compared with men (RR ratios: 1.90; 95% CI: 1.69-2.14 versus 1.68; 95% CI: 1.56-1.80). This association persisted even in women who smoked 1 to 10 packs per year (RR ratios: 2.02; 95% CI: 1.65 to 2.48 versus 1.38; 95% CI: 1.22 to 1.57). In the older group, rates of STEMI were similar for women and men (RR ratios: 1.36; 95% CI: 1.22-1.53 versus 1.39; 95% CI: 1.28-1.50). STEMI was associated with a twofold higher 30-day mortality rate in young middle age women compared with men of the same age (odds ratios, 5.54; 95% CI, 3.83-8.03 vs. 2.93; 95% CI, 2.33-3.69). CONCLUSIONS: Low intensity smoking provides inadequate protection in young - middle age women as they still have a substantially higher rate of STEMI and related mortality compared with men even smoking less than 10 packs per year. This finding is worrying as more young - middle age women are smoking, and rates of smoking among young-middle age men continue to fall.
BACKGROUND AND AIMS: An increasing proportion of women believe that smoking few cigarettes daily substantially reduces their risk of developing cardiovascular (CV) related disorders. The effect of low intensity smoking is still largely understudied. We investigated the relation among sex, age, cigarette smoking and ST segment elevation myocardial infarction (STEMI) as initial manifestation of CV disease. METHODS: We analyzed data of 50,713 acute coronary syndromepatients with no prior manifestation of CV disease from the ISACS-Archives (NCT04008173) registry. We compared the rates of STEMI in current smokers (n = 11,530) versus nonsmokers (n = 39,183). RESULTS: In the young middle age group (<60 years), there was evidence of a more harmful effect in women compared with men (RR ratios: 1.90; 95% CI: 1.69-2.14 versus 1.68; 95% CI: 1.56-1.80). This association persisted even in women who smoked 1 to 10 packs per year (RR ratios: 2.02; 95% CI: 1.65 to 2.48 versus 1.38; 95% CI: 1.22 to 1.57). In the older group, rates of STEMI were similar for women and men (RR ratios: 1.36; 95% CI: 1.22-1.53 versus 1.39; 95% CI: 1.28-1.50). STEMI was associated with a twofold higher 30-day mortality rate in young middle age women compared with men of the same age (odds ratios, 5.54; 95% CI, 3.83-8.03 vs. 2.93; 95% CI, 2.33-3.69). CONCLUSIONS: Low intensity smoking provides inadequate protection in young - middle age women as they still have a substantially higher rate of STEMI and related mortality compared with men even smoking less than 10 packs per year. This finding is worrying as more young - middle age women are smoking, and rates of smoking among young-middle age men continue to fall.