Heart and tobacco: more and more women affected

Women are as likely as men to develop and die from many diseases caused by smoking[1]. In addition, they face gender-specific risks that are still too often underestimated.

Cardiovascular disease is a leading cause of death worldwide. Although the incidence of cardiovascular disease in women is generally lower than in men, women have higher mortality and a worse prognosis after acute cardiovascular events.[2]The risk of cardiovascular disease in women is often underestimated. This is due to misperceptions that these are "male" diseases or that women are more "protected" than men against cardiovascular disease due to their hormonal status. In reality, this real benefit disappears when tobacco is consumed and women are then as vulnerable as men to tobacco-induced diseases.[3].

A worrying situation in France[4]

The smoking rate among women continues to decline in France. According to the latest bulletin from Public Health France from May 2020[5], between 2018 and 2019, the percentage of women reporting that they smoked daily fell from 22.9 % to 20.7 %. However, while the decrease is real for younger women (18 to 34 years old), there is a continuing increase among women over 55. This generational effect corresponds to the massive entry into smoking among women in the 1970s.[6] and who have not stopped. The growth of female smoking is a direct result of the tobacco industry's marketing strategies, which have tailored their products, brands, and campaigns to women and continue this deliberate targeting today. [7]-[8].

As a result, between 2000 and 2014 in France, deaths attributable to tobacco among women doubled, the mortality rate from lung cancer among women has now exceeded that of breast cancer, it increased by 71% among women aged 55 to 64 while it decreased by 15% among men. The incidence of myocardial infarction before age 65 increased by 50% among women (16% among men). Among women aged 35 to 49, more than 25% of deaths from coronary disease are attributable to tobacco.

The challenge of a gender-based approach and completely stopping smoking

It is important to consider sex and gender characteristics in the prevention, diagnosis, treatment, and management of cardiovascular diseases. To achieve the goal of a tobacco-free generation in France by 2032, it is important not only to prevent young people from starting to smoke but also to address adult smoking, particularly among women, to provide appropriate support in quitting.

The health benefits of quitting smoking are very rapid, and contrary to popular belief, there is no threshold below which smoking is considered safe. Thus, the risks are present even when smoking one cigarette a day.[9]. The factor of the duration of smoking is decisive. However, if stopping smoking early in life considerably reduces the risks of contracting cardiovascular disease[10], benefits exist at all ages. At age 60, quitting smoking allows you to gain, on average, 3 years of life expectancy. In addition, quitting smoking is an essential factor in preventing the recurrence of cardiovascular accidents. Thus, smokers who quit smoking after a heart attack reduce the risk of death by 36% and the risk of a new attack by 32%¹¹.

Keywords: Women, tobacco, heart   Photo credit: PHANIE photography press agency ©Generation Without Tobacco

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[1] Marjan Walli-Attaei, PhD Philip Joseph, MD Prof Annika Rosengren, MD Prof Clara K Chow, PhD Sumathy Rangarajan, MSc Prof Scott A Lear, PhD et al. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study, The Lancet, VOLUME 396, ISSUE 10244, P97-109, JULY 11, 2020 DOI:https://doi.org/10.1016/S0140-6736(20)30543-2 [2] Zujie Gao, Zengsheng Chen, Anqiang Sun, Xiaoyan Deng,Gender differences in cardiovascular disease,Medicine in Novel Technology and Devices, Volume 4,2019,100025,ISSN 2590-0935,https://doi.org/10.1016/j.medntd.2019.100025. [3] Professor Daniel THOMAS, The “Heart of Women” Victim of Tobacco, Forbes, December 5, 2020, accessed December 11, 2020 [4] Tobacco-related pathologies in women: a situation that remains evolving and alarming, French Federation of Cardiology, November 6, 2018, consulted on December 11, 2020 [5] Pasquereau A, Andler R, Arwidson P, Guignard R, Nguyen-Thanh V. Tobacco consumption among adults: a five-year review of the national tobacco control program, 2014-2019. Bull Epidémiol Hebd. 2020;(14):27381. http://beh.santepubliquefrance.fr/beh/2020/14/2020_14_1.html [6] Ibid [7] The scourge of female smoking, a consequence of tobacco industry advertising strategies, CNCT, October 31, 2018, consulted on December 11, 2020 [8] Women remain a major target for the tobacco industry, Tobacco-Free Generation, April 21, 2020, accessed December 11, 2020 [9] Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018 Jan 24;360:j5855. doi:10.1136/bmj.j5855. Erratum in: BMJ. 2018 Apr 11;361:k1611. Erratum in: BMJ. 2018 Nov 28;363:k5035. PMID: 29367388; PMCID: PMC5781309. [10] Quitting smoking early significantly reduces the risk of death from cardiovascular disease, Generation Without Tobacco, November 5, 2020 consulted on December 11, 2020 ¹¹ Critchley JA, Capwell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease. A systematic review. JAMA 2003;290:86–97. National Committee Against Smoking |