Smoking Affects STEMI Risk More for Women Than Men

woman smoking cigarettes
Cigarette smoking increased the risk for acute myocardial infarction to a greater degree in young women than in men. The risk for STEMI in ex-smokers was similar to that in people who never smoked.

Smoking significantly increases the risk for acute ST-segment elevation myocardial infarction (STEMI) in both men and women, but women have a significantly higher risk for STEMI than men, according to results published in the Journal of the American College of Cardiology.

The study included data from patients who had an acute STEMI and were seen in a tertiary cardiothoracic center in the United Kingdom between 2009 and 2014 (n=3343). The researchers combined participant data with population data to generate incidence rates of STEMI.

They calculated age-standardized incidence rate ratios (IRRs) using the Poisson distribution and then compared STEMI rates between smokers and nonsmokers stratified by sex and 3 age groups: 18 to 49, 50 to 64, and >65 years.

The participants contributed a total of 5,639,328 person-years. The researchers found that the highest STEMI rate for current smokers was in the 70 to 79 years age range for women (235 per 100,000 person-years) and 50 to 59 years for men (425 per 100,000 person-years).

The results indicated that smoking was associated with a significantly higher increase in STEMI rate for women compared with men (IRR, 6.62; 95% CI, 5.98-7.31 vs IRR, 4.40; 95% CI, 4.15-4.67). The most significant increase was seen in women in the 18 to 49 age group (IRR, 13.22; 95% CI, 10.33-16.66) compared with men in the same age group (IRR, 8.60; 95% CI, 7.70-9.59).

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The researchers found the greatest risk difference in the 50 to 64 age group, with an IRR of 9.66 (95% CI, 8.30-11.18) in women compared with 4.47 (95% CI, 4.10-4.86) in men.

“Patients who smoke merit encouragement to give up their habit, and this study adds quantitative evidence to the benefits of doing so,” the researchers wrote.


Palmer J, Lloyd A, Steele L, et al. Differential risk of ST-segment elevation myocardial infarction in male and female smokers.J Am Coll Cardiol. 2019;73(25):3259-3266.