STEMI risk for smokers is especially high among young women

  • J Am Coll Cardiol

  • International Clinical Digest
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Takeaway

  • Young women (ages 18-49 years) have a “striking” increase in risk for ST-elevation myocardial infarction (STEMI) if they smoke, by more than 13-fold.

Why this matters

  • Although smoking is well known for its role in STEMI risk, this study uncovers a strong age and sex effect. 
  • Editorial: clinicians need to engage better with patients about smoking cessation. 

Key results

  • Peak STEMI rates were in 70-79-year and 50-59-year age ranges for women (235 per 100,000 patient-years) and men (425 per 100,000 patient-years), respectively.
  • Women who smoked had higher STEMI risk increase vs men who smoked (both compared with nonsmokers):
    • Incidence rate ratio (IRR), women: 6.62 (95% CI, 5.98-7.31).
    • IRR, men: 4.40 (95% CI, 4.15-4.67).
    • Women aged 18-49 years had the greatest increase: 
      • IRR: 13.22 (95% CI, 10.35-16.66).
  • The greatest difference by age and sex was for those ages 50-64 years:
    • Women, IRR: 9.66 (95% CI, 8.30-11.18).
    • Men, IRR: 4.47 (95% CI, 4.10-4.86).
  • Even the involved artery differed by sex, likelier to be the right coronary artery in women vs men.

Study design

  • Retrospective cohort study, patients attending a UK tertiary cardiothoracic center, 2009-2014, with acute STEMI (3343 STEMIs; 27.3% women). 
  • Funding: None disclosed.

Limitations

  • No information about smoking duration, quantity.