Women worst hit by smoking

By Dr. Ananya Mandal, MDAug 12 2011

A study published in the British medical journal `The Lancet' on Thursday revealed that the risk of developing coronary heart disease is 25% higher for women smokers compared with men.

The researchers write that the difference between sexes could be physiological sexes with cigarette smoke toxins having a more potent effect on women. India ranks third in the top 20 female smoking populations across the globe. With around a 10 million female smokers in India, only the US with 23 million female smokers and China with 13 million  female smokers, are worse off. Worldwide, there are 1.1 billion smokers, of whom a fifth are women.

The study came from Dr Rachel R Huxley from the University of Minnesota and Dr Mark Woodward from Johns Hopkins University who performed a meta-analysis of around four million individuals and 67,000 coronary heart disease events from 86 studies. The researchers found that the pooled adjusted female-to-male relative risk ratio (RRR) of smoking compared with not smoking for coronary heart disease (CHD) was 1.25 (25%) higher for women. This RRR increased by 2% for every additional year of follow-up, meaning that the longer a woman smokes, the higher her risk of developing CHD becomes compared with a man who has smoked the same length of time.

The study reads, “The finding lends support to the idea of a pathophysiological basis for the sex difference. For example, women might extract a greater quantity of carcinogens and other toxic agents from the same number of cigarettes than men. This occurrence could explain why women who smoke have double the risk of lung cancer compared with their male counterparts.”

Every year, more than 5 million deaths occur that are directly attributed to tobacco, with 1.5 million of these deaths occurring in women. These figures are projected to increase to 8 million female smokers and 2.5 million deaths in women by 2030 if present patterns of smoking persist.

In a linked comment, Dr Matthew Steliga from the University of Arkansas says, “What makes the realization that women are at increased risk worrisome is that the tobacco industry views women as its growth market.” By 2030, coronary heart disease will be the main cause of death globally, and will be responsible for 9.6 million deaths - or 14% of the total every year. The linked comment added, “In most societies smoking rates are higher for men than for women, but more men than women are giving up, and in some societies the number of female smokers is rising. With billions of pounds to spend on marketing -- by contrast with paltry funding for tobacco control -- the tobacco industry continues to see a rise in profits globally. Thus, despite some success in reduction of smoking prevalence in men, the rise or even stabilization of smoking in women will unfortunately result in substantial, preventable coronary heart disease morbidity and mortality.”

Tobacco-control programs should consider women, particularly in those countries where smoking among young women is increasing in prevalence the authors added. The study was large and examined a diverse range of populations worldwide, with consistent findings, Huxley and Woodward said. They also acknowledged limitations of the research, such as an inability to take use of birth control pills into account in the analysis. Studies also defined non-smokers differently, with some including those who had never smoked and others defining them as not-current smokers.

In most societies, smoking rates are higher for men than for women, but more men than women are quitting, wrote Dr. Carolyn Dresler journal in a commentary that accompanies the research paper. Dresler of the Tobacco Prevention and Cessation Program at the Arkansas Department of Health, in Little Rock added, “What makes the realization that women are at increased risk worrisome is that the tobacco industry views women as its growth market.” Tobacco companies are increasingly targeting women with slim brands and slick packaging,” said Ellen Mason, senior cardiac nurse at the British Heart Foundation. Mason suggested introducing plain packaging to increase the effectiveness of health warnings and to reduce the appeal of tobacco products.