Tobacco Use and Cardiovascular Risk in Women

Smoking is a significant contributor to the incidence, mortality, and risk factors for cardiovascular disease (CVD) in women. Smoking is the most important preventable cause of CVD in women younger than 55 years, with sevenfold increased risk. Women are shown to be more at risk from long-term smoking than men. It is unclear if biological factors or differences in smoking behavior account for the sex differences. According to some authors, absorption, or pathophysiological effects of toxins from cigarette smoke might be greater in women. However, more research is needed into the mechanisms that contribute to this elevated risk and to the possible sex differences. A non-linear dose–response relationship exists between smoking and the risk of CVD and mortality. There is no safe lower limit for smoking and all forms, including occasional smoking, passive smoking, snuffing, and electronic cigarettes, are harmful. Quitting smoking is the most effective strategy for CVD prevention. Equal access to therapies based on recommendations and resources to aid in quitting smoking should be provided to both men and women and they should receive the same access to guideline-based treatments. In smokers, offering follow-up support, nicotine replacement therapy, varenicline, and bupropion individually or in combination should be considered. Smoking cessation may contribute to an increase in obesity in the population, but it is still advised to stop smoking regardless of weight gain because the advantages of quitting for CVD are not diminished by weight gain.