Women, smoking and myocardial infarction

Abstract: The aim of this thesis has been to explore factors associated with smoking and smoking cessation in women and the relation between smoking and incidence of myocardial infarction (MI). The time trends in incidence of MI 1986-2002 in the city of Malmö (pop. 250.000) were explored. It showed declining incidences in men and older women, but not in women below 65 years of age. The high prevalence of smokers could possibly explain the absence of decline. In a cohort study of 10 902 middle-age women followed over 14 years, it was concluded that many of the MI events in smokers and ex-smokers can be attributed to other cardiovascular risk factor e.g. hypertension, diabetes and high cholesterol. There was a significant interaction between smoking and hypertension on risk of MI. This illustrates the need of a global risk factor assessment in smokers. Within the city of Malmö there are marked differences between residential areas with regard to the socio-economic circumstances. A cross-sectional study of 17 319 women showed marked differences of the area-specific prevalence of smoking. The prevalence of smoking was related to several unfavourable socio-economic circumstances. The area specific incidence of MI among women was strongly related to the prevalence of smoking, particularly in younger age groups. Fear of weight gain after smoking cessation is an obstacle for many female smokers who consider to quit. A cross-sectional study of 3 931 women showed that smokers on average have lower body weight and lower blood pressure than have non-smokers. During nine years follow-up, the weight increase was 3-4 kg higher in women who quit than it was in those who had never smoked. Smoking cessation was also associated with a moderate increase of both the systolic and diastolic blood pressure and a higher incidence of hypertension. A number of socio-economic and psycho-social circumstances e.g. civil status, educational level, annual income, availability of emotional support, exposure to passive smoking, body weight and self perceived health were in a cross-sectional study associated with women's ability to quit smoking. It is concluded that by using epidemiological methods it is possible to identify target groups for tobacco preventive measures.