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Cardiovascular Risk Among Patients Who Smoke: Risk Profiles and Differences by Sex

  • Ingrid Allagbé
    Correspondence
    Address correspondence to: Ingrid Allagbe, MPH, Physiopathology and Epidemiology Cerebro-cardiovascular (PEC2, EA 7460), Faculty of Health Science (UFR des Sciences de Santé), University of Burgundy Franche Comté, Dijon 21000, France.
    Affiliations
    Physiopathology and Epidemiology Cerebro-cardiovascular (PEC2, EA 7460), Faculty of Health Science (UFR des Sciences de Santé), University Burgundy and Franche-Comté, Dijon, France

    Outpatient Addictology Center, AP-HP Center, University of Paris, Paris, France

    Groupement d'intérêt Scientifique du Réseau français d'excellence de Recherche sur Tabac, nicotine et produit connexes (GIS REfer Tab), Paris, France
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  • Marianne Zeller
    Affiliations
    Physiopathology and Epidemiology Cerebro-cardiovascular (PEC2, EA 7460), Faculty of Health Science (UFR des Sciences de Santé), University Burgundy and Franche-Comté, Dijon, France

    Groupement d'intérêt Scientifique du Réseau français d'excellence de Recherche sur Tabac, nicotine et produit connexes (GIS REfer Tab), Paris, France
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  • Daniel Thomas
    Affiliations
    Groupement d'intérêt Scientifique du Réseau français d'excellence de Recherche sur Tabac, nicotine et produit connexes (GIS REfer Tab), Paris, France

    Institut de Cardiologie, Hôpital Pitié Salpêtrière, AP-HP, Université Paris-Sorbonne, Paris, France
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  • Guillaume Airagnes
    Affiliations
    Outpatient Addictology Center, AP-HP Center, University of Paris, Paris, France
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  • Frédéric Limosin
    Affiliations
    DMU Psychiatry and Addictology, AP-HP Centre-University of Paris, Paris, France
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  • Abdelali Boussadi
    Affiliations
    Medical Informatics, Biostatistics and Public Health Department, Georges Pompidou University Hospital, Paris, France
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  • Frédéric Chagué
    Affiliations
    Groupement d'intérêt Scientifique du Réseau français d'excellence de Recherche sur Tabac, nicotine et produit connexes (GIS REfer Tab), Paris, France

    Cardiology Department, Dijon University Hospital, Dijon, France
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  • Anne-Laurence Le Faou
    Affiliations
    Outpatient Addictology Center, AP-HP Center, University of Paris, Paris, France

    Groupement d'intérêt Scientifique du Réseau français d'excellence de Recherche sur Tabac, nicotine et produit connexes (GIS REfer Tab), Paris, France

    DMU Psychiatry and Addictology, AP-HP Centre-University of Paris, Paris, France

    University Hospital Federation – Network of Research in Substance Use Disorder, Paris, France
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      Introduction

      Smoking is particularly harmful to the cardiovascular system, and smoking-cessation is a key target for cardiovascular prevention. From a large nationwide database on subjects who visited smoking-cessation services, this study assessed the profile and abstinence rate comparing female with male smokers at high cardiovascular risk.

      Methods

      This was an observational study from the French smoking-cessation services cohort (French national cohort Consultations de Dépendance Tabagique) between 2001 and 2018. Inclusion criteria were being aged ≥18 years and having ≥1 cardiovascular risk factor. Abstinence was self-reported (stopping cigarettes or other tobacco products use ≥28 consecutive days) and confirmed by exhaled carbon monoxide <10 parts per million. Analysis was conducted in 2021.

      Results

      Among 36,864 people who smoke, 15,407 (42%) were women. Women were 3 years younger (48 vs 51 years, p<0.001) and more educated (≥high school diploma: 54% vs 45%, p<0.001) than men. The burden of cardiovascular risk factors was slightly lower in women than in men and, for hypercholesterolemia, hypertension, diabetes, and cardiovascular diseases, were half as frequent in women as they were in men (16% vs 32%, p<0.001). However, women suffered more often from obesity, respiratory diseases, and anxiety‒depression symptoms (53% vs 39%, p<0.001). Finally, although women were less nicotine dependent, their abstinence rate was slightly lower (52.6% vs 55.2%, p<0.001).

      Conclusions

      Women who smoked had a high burden of risk factors, especially obesity and elevated rates of lung diseases, and a lower abstinence rate, with more common anxiety‒depression symptoms. Men who smoked had a higher prevalence of cardiovascular disease, higher nicotine dependence, and coaddictions. These findings highlight the need to strengthen cardiovascular prevention strategies through comprehensive sex-tailored smoking-cessation interventions.
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      REFERENCES

        • Yusuf S
        • Hawken S
        • Ounpuu S
        • et al.
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.
        Lancet. 2004; 364: 937-952https://doi.org/10.1016/S0140-6736(04)17018-9
        • Visseren FLJ
        • Mach F
        • Smulders YM
        • et al.
        2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.
        Eur Heart J. 2021; 42: 3227-3337https://doi.org/10.1093/eurheartj/ehab484
        • Allagbé I
        • Le Faou AL
        • Thomas D
        • et al.
        Tobacco-related cardiovascular risk in women: new issues and therapeutic perspectives.
        Arch Cardiovasc Dis. 2021; 114: 694-706https://doi.org/10.1016/j.acvd.2021.06.013
        • Bonaldi C
        • Boussac M
        • Nguyen-Thanh V.
        Estimation of deaths attributable to tobacco smoking, in France from 2000 to 2015.
        Bull Epidémiol Hebd. 2019; 15: 278-284https://doi.org/10.13140/RG.2.2.31002.49601
        • Jensen J
        • Christiansen C
        • Rødbro P.
        Cigarette smoking, serum estrogens, and bone loss during hormone-replacement therapy early after menopause.
        N Engl J Med. 1985; 313: 973-975https://doi.org/10.1056/NEJM198510173131602
      1. Manzo-Silberman S, Vautrin E, Bellemain-Appaix A, et al. Prospective study in young women presenting acute myocardial infarction in France: clinical, morphological and biological descriptive analysis: WAMIF Study. Arch Cardiovasc Dis Suppl. 2021;13(1):153. https://doi.org/10.1016/j.acvdsp.2020.10.324.

        • Olié V
        • Pasquereau A
        • Assogba FAG
        • et al.
        Trends of smoking-related morbidity and mortality in women in metropolitan france: an alarming situation.
        Bull Epidémiol Hebd. 2018; 35-46: 683-694
        • Huxley RR
        • Woodward M.
        Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies.
        Lancet. 2011; 378: 1297-1305https://doi.org/10.1016/S0140-6736(11)60781-2
        • Yang LX
        • Wang ZJ
        • Shi DM
        • et al.
        Differential impact of cigarette smoking on prognosis in women and men undergoing percutaneous coronary intervention.
        Angiology. 2020; 71: 281-287https://doi.org/10.1177/0003319719889276
        • Messner B
        • Bernhard D.
        Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis.
        Arterioscler Thromb Vasc Biol. 2014; 34: 509-515https://doi.org/10.1161/ATVBAHA.113.300156
        • Kawachi I
        • Colditz GA
        • Stampfer MJ
        • et al.
        Smoking cessation and time course of decreased risks of coronary heart disease in middle-aged women.
        Arch Intern Med. 1994; 154: 169-175https://doi.org/10.1001/archinte.1994.00420020075009
        • Ponikowski P
        • Voors AA
        • Anker SD
        • et al.
        2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2200https://doi.org/10.1093/eurheartj/ehw128
        • Baha M
        • Boussadi A
        • Le Faou AL
        French smoking cessation services provide effective support even to the more dependent.
        Prev Med. 2016; 90: 34-38https://doi.org/10.1016/j.ypmed.2016.06.024
        • Cornelius ME
        • Wang TW
        • Jamal A
        • Loretan CG
        • Neff LJ.
        Tobacco product use among adults - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1736-1742https://doi.org/10.15585/mmwr.mm6946a4
      2. Body mass index – BMI. WHO.https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Updated May 6, 2010. Accessed October 13, 2021.

        • Mykletun A
        • Stordal E
        • Dahl AA.
        Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population.
        Br J Psychiatry. 2001; 179: 540-544https://doi.org/10.1192/bjp.179.6.540
        • Heatherton TF
        • Kozlowski LT
        • Frecker RC
        • Rickert W
        • Robinson J.
        Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day.
        Br J Addict. 1989; 84: 791-799https://doi.org/10.1111/j.1360-0443.1989.tb03059.x
        • Ren Y
        • Chase E
        • d'Almeida T
        • et al.
        Modelling the number of avoidable new cancer cases in France attributable to alcohol consumption by following official recommendations: a simulation study.
        Addiction. 2021; 116: 2316-2325https://doi.org/10.1111/add.15426
        • Fidler JA
        • Shahab L
        • West O
        • et al.
        The smoking toolkit study”: a national study of smoking and smoking cessation in England.
        BMC Public Health. 2011; 11: 479https://doi.org/10.1186/1471-2458-11-479
        • Dorner TE
        • Tröstl A
        • Womastek I
        • Groman E.
        Predictors of short-term success in smoking cessation in relation to attendance at a smoking cessation program.
        Nicotine Tob Res. 2011; 13: 1068-1075https://doi.org/10.1093/ntr/ntr179
        • Jeong BY
        • Lim MK
        • Yun EH
        • Oh JK.
        User characteristics of national smoking cessation services in Korea: who chooses each type of tobacco cessation program?.
        BMC Health Serv Res. 2019; 19: 14https://doi.org/10.1186/s12913-018-3817-z
        • Affret A
        • Luc A
        • Baumann C
        • et al.
        Effectiveness of the e-Tabac Info Service application for smoking cessation: a pragmatic randomised controlled trial.
        BMJ Open. 2020; 10e039515https://doi.org/10.1136/bmjopen-2020-039515
        • Veronesi G
        • Ferrario MM
        • Kuulasmaa K
        • et al.
        Educational class inequalities in the incidence of coronary heart disease in Europe.
        Heart. 2016; 102: 958-965https://doi.org/10.1136/heartjnl-2015-308909
        • Gallucci G
        • Tartarone A
        • Lerose R
        • Lalinga AV
        • Capobianco AM.
        Cardiovascular risk of smoking and benefits of smoking cessation.
        J Thorac Dis. 2020; 12: 3866-3876https://doi.org/10.21037/jtd.2020.02.47
        • Gurm Z
        • Seth M
        • Daher E
        • et al.
        Prevalence of coronary risk factors in contemporary practice among patients undergoing their first percutaneous coronary intervention: implications for primary prevention.
        PLoS One. 2021; 16e0250801https://doi.org/10.1371/journal.pone.0250801
        • Craig WY
        • Palomaki GE
        • Haddow JE.
        Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data.
        BMJ. 1989; 298: 784-788https://doi.org/10.1136/bmj.298.6676.784
        • Clair C
        • Augsburger A
        • Birrer P
        • et al.
        Assessing the efficacy and impact of a personalised smoking cessation intervention among type 2 diabetic smokers: study protocol for an open-label randomised controlled trial (DISCGO-RCT).
        BMJ Open. 2020; 10e040117https://doi.org/10.1136/bmjopen-2020-040117
        • Reynoso J
        • Susabda A
        • Cepeda-Benito A.
        Gender differences in smoking cessation.
        J Psychopathol Behav Assess. 2005; 27: 227-234https://doi.org/10.1007/s10862-005-0638-2
        • Pogun S
        • Yararbas G.
        Sex differences in nicotine action.
        Handb Exp Pharmacol. 2009; : 261-291https://doi.org/10.1007/978-3-540-69248-5_10
        • Gallus S
        • Lugo A
        • Liu X
        • et al.
        Who smokes in Europe? Data from 12 European countries in the TackSHS Survey (2017–2018).
        J Epidemiol. 2021; 31: 145-151https://doi.org/10.2188/jea.JE20190344
        • Perkins KA
        • Donny E
        • Caggiula AR.
        Sex differences in nicotine effects and self-administration: review of human and animal evidence.
        Nicotine Tob Res. 1999; 1: 301-315https://doi.org/10.1080/14622299050011431
        • Perkins KA
        • Scott J.
        Sex differences in long-term smoking cessation rates due to nicotine patch.
        Nicotine Tob Res. 2008; 10: 1245-1250https://doi.org/10.1080/14622200802097506
        • Han JK
        • Yano EM
        • Watson KE
        • Ebrahimi R.
        Cardiovascular care in women veterans.
        Circulation. 2019; 139: 1102-1109https://doi.org/10.1161/CIRCULATIONAHA.118.037748
        • Harshfield EL
        • Pennells L
        • Schwartz JE
        • et al.
        Association between depressive symptoms and incident cardiovascular diseases.
        JAMA. 2020; 324: 2396-2405https://doi.org/10.1001/jama.2020.23068
        • Shah AJ
        • Ghasemzadeh N
        • Zaragoza-Macias E
        • et al.
        Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events.
        J Am Heart Assoc. 2014; 3e000741https://doi.org/10.1161/JAHA.113.000741
        • Vozoris NT
        • Stanbrook MB.
        Smoking prevalence, behaviours, and cessation among individuals with COPD or asthma.
        Respir Med. 2011; 105: 477-484https://doi.org/10.1016/j.rmed.2010.08.011
        • Chen Y
        • Horne SL
        • Dosman JA.
        Increased susceptibility to lung dysfunction in female smokers.
        Am Rev Respir Dis. 1991; 143: 1224-1230https://doi.org/10.1164/ajrccm/143.6.1224
        • Xu X
        • Li B
        • Wang L.
        Gender difference in smoking effects on adult pulmonary function.
        Eur Respir J. 1994; 7: 477-483https://doi.org/10.1183/09031936.94.07030477
        • Reid RD
        • Pipe AL
        • Quinlan B.
        Promoting smoking cessation during hospitalization for coronary artery disease.
        Can J Cardiol. 2006; 22: 775-780https://doi.org/10.1016/s0828-282x(06)70294-x
        • Sadeghi M
        • Shabib G
        • Masoumi G
        • et al.
        A systematic review and meta-analysis on the prevalence of smoking cessation in cardiovascular patients after participating in cardiac rehabilitation.
        Curr Probl Cardiol. 2021; 46100719https://doi.org/10.1016/j.cpcardiol.2020.100719