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Smoking and Risk of Premature Atherosclerotic Cardiovascular Disease

Published:November 16, 2021DOI:https://doi.org/10.1016/j.amepre.2021.08.019
      INTRODUCTION Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for women in the U.S. and worldwide.
      • Benjamin EJ
      • Muntner P
      • Alonso A
      • et al.
      Heart disease and stroke statistics-2019 update: a report from the American Heart Association [published correction appears in Circulation. 2020;141(2):e33].
      Overall, 1 in 3 women die from CVD, and 45% of women aged >20 years have some form of CVD.
      • Benjamin EJ
      • Muntner P
      • Alonso A
      • et al.
      Heart disease and stroke statistics-2019 update: a report from the American Heart Association [published correction appears in Circulation. 2020;141(2):e33].
      Awareness of risk factors is critical in reducing cardiovascular risk in women.
      • Cho L
      • Davis M
      • Elgendy I
      • et al.
      Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC State-of-the-Art Review.
      Women's awareness that heart disease is a leading cause of death among women has declined from 64.8% in 2009 to 43.7% in 2019, and of further concern, this decline was greatest among women aged 25–34 years and in those with CVD risk factors.
      • Cushman M
      • Shay CM
      • Howard VJ
      • et al.
      Ten-year differences in women's awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report from the American Heart Association.
      Among CVD risk factors, smoking was the second leading cause of disability-adjusted life years lost in the U.S. in 2016.
      • Virani SS
      • Alonso A
      • Benjamin EJ
      • et al.
      Heart disease and stroke statistics-2020 update: a report from the American Heart Association.
      Data are lacking regarding the effect of smoking on premature atherosclerotic CVDs (ASCVDs), especially among women who are often thought to be at elevated risk of ASCVD only at later stages in life. Among adults in the U.S., men are more likely to be current smokers than women (15.3% vs 12.7%).
      Current cigarette smoking among adults in the United States.
      Among low-risk lifestyle-related factors, not smoking is one of the major factors to prolong life expectancy at age 50 years for both women and men.
      • Li Y
      • Pan A
      • Wang DD
      • et al.
      Impact of healthy lifestyle factors on life expectancies in the U.S. population [published correction appears in Circulation. 2018;138(4):e75].
      Therefore, the authors evaluated the association of smoking with the risk of ASCVD in young women and men. This study was approved by the Kaiser Permanente IRB.
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