Abstract 13411: Cigarette Smoking is Associated With a Greater Hazard for Adverse Outcomes in Women Compared With Men: Insights From the Global REACH Registry
Introduction: Cigarette smoking is the leading preventable cause of death worldwide. Few global studies have quantified the harmful effects of smoking in women compared with men, especially in non-Western countries where smoking rates are increasing.
Study Aim: We compared the harmful effects of smoking between women and men enrolled in a global cardiovascular disease (CVD) registry.
Methods: The REACH registry included 43,795 subjects (35.5% women) with known CVD (coronary, cerebrovascular, or peripheral artery disease) or multiple CVD risk factors from 29 countries (33.3% non-Western countries) who provided their smoking status at baseline and completed 4-year follow-up. Subjects were classified as current, former, or never smokers, and the multivariable adjusted 4-year hazard ratios (HR) of all-cause death, and the composite of all-cause death, MI, or stroke were compared across smoking groups in both sexes.
Results: Prevalence rates of current and former smoking were higher in men (18.0% and 52.8%) than in women (11.4% and 21.0%). However, the risk of all-cause death in current versus never smokers was higher in women (adjusted HR 1.99, 95% CI 1.66-2.38) than men (adjusted HR 1.53, 95% CI 1.36-1.76, interaction P value by sex = 0.028) (Figure). The adjusted risks of current versus never smoking were also greater in women than men for the composite of all-cause death, MI, or stroke (Figure). In women, the risks associated with smoking were similar in Western and non-Western countries (interaction P value by world region = 0.49 for all-cause death, and 0.80 for the composite endpoint).
Conclusion: In this global CVD registry, prevalence rates of current and former smoking were higher in men than women, but current and former smoking were associated with greater adjusted risks for adverse outcomes in women compared with men. Tobacco control programs should target both women and men to minimize tobacco-related harm in Western and non-Western countries.
- © 2013 by American Heart Association, Inc.