WebMD Medical News
Laura J. Martin, MD
Oct. 7, 2011 -- Smokers have heart attacks earlier than nonsmokers, and women smokers are also much more likely than men smokers to have complications after a heart attack, new research shows.
"Female smokers after a heart attack have about a two and a half times greater event rate -- things like recurrent heart attacks -- over a six-month follow-up," says researcher Elizabeth Jackson, MD, MPH. Jackson is an assistant professor of medicine at the University of Michigan Cardiovascular Center, Ann Arbor.
Her research was published online in the American Journal of Cardiology.
While Jackson discourages both men and women from smoking, the new study finds that women smokers do much worse in that period after an attack than do men smokers.
Jackson used the University of Michigan Health System's acute coronary event registry to study smoking and heart attacks.
The registry includes data on 3,588 patients. All had been admitted to the University Medical Center from 1999 through 2006. All had a diagnosis of an acute coronary syndrome event, such as a heart attack.
In all, 24% of patients were active smokers. The men who smoked were nine years younger than the nonsmoking men when they were hospitalized for the heart problem. Women smokers were 13 years younger than nonsmoking women when admitted.
The average age of the nonsmoking men was 64 and of the smoking men, 55. The average age of the nonsmoking women was 69 and of the smoking women, 56.
Jackson followed the patients for six months. When she looked only at the smokers, the women had greater chances of complications six months later than the men did.
At six months, 4.4% of the male smokers needed emergency care to restore blood flow. But 13.5% of the women smokers did.
After leaving the hospital, women overall were less likely to receive medical treatment such as aspirin or other drugs to reduce heart attack risk factors, the researchers found.
In the study, the men who smoked had a lower death rate and fewer heart events six months later than nonsmokers, Jackson found. She says it has long been known that if you compare people of all ages who have heart attacks and then look at smokers vs. nonsmokers, the smokers do better in terms of surviving the heart attack.
However, she and other experts believe that is a ''pseudo'' benefit. The smokers are having their heart attacks at earlier ages than the nonsmokers, she says. And the nonsmokers, in general, have more coexisting problems simply because they are older. That can affect their risk of dying after the heart attack.
Exactly why women smokers fare worse with heart attack complications was not addressed in the study, Jackson tells WebMD.
There are a number of possible reasons, she says. One is that women's coronary arteries are typically smaller than men's. Smaller blood clots may block the vessels and trigger a heart attack.
A woman's body may respond differently to smoking than does a man's.
The new findings echo much of what is known, says Marianne Legato, MD. She is founder and director of The Partnership for Gender-Specific Medicine at Columbia University and professor of clinical medicine there.
Legato points to one finding as extremely important -- that the women, whether they smoked or not, were less likely to receive medical therapy at discharge. This included aspirin, statins for lowering cholesterol, and other medicines to lower blood pressure.
"Women when discharged are not getting the careful regimens men do," she tells WebMD. "This is an important reason for complications six months down the line."
Quitting smoking is the obvious advice, Jackson says. "If you are smoking and you do unfortunately have a heart attack, you should quit immediately. Most people know that, but it's easier said than done."
"Although I can't say from this data that women who stop do better [after a heart attack], it's a logical conclusion," she says.
Legato adds this advice for women who have had a heart attack: "They have to ask their doctor if they have received all the appropriate medication to prevent a future event when they leave the hospital."
SOURCES:Elizabeth Jackson, MD, MPH, assistant professor of medicine, University of Michigan Cardiovascular Center, Ann Arbor.Marianne Legato, MD, adjunct professor of medicine, Johns Hopkins University, professor of clinical medicine; founder and director, The Partnership for Gender-Specific Medicine, Columbia University.Howe, M. The American Journal of Cardiology, publishedonline Sept. 19, 2011.
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