https://doi.org/10.1007/s00392-025-02625-4
1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Klinikum Lippe-Detmold Universitätsklinik für Kardiologie, Angiologie, Intensivmedizin Detmold, Deutschland; 3Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin, Kardiologie und Intensivmedizin Dresden, Deutschland; 4Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland
Introduction:
While in general population the rate of male smokers is above the rate of female smokers (26% vs. 20%, ESA 2021), a recent meta-analysis of 14 cohort studies reported that smoking in women is associated with a higher cardiovascular risk than in men (Hackshaw et al., BMJ 2018). The present study investigates sex-specific smoking rates at hospital admission for acute myocardial infarction (MI) in two German multicenter MI-trials and analyzes the effects of a 12-months intensive prevention program (IPP) on smoking.
Methods:
The German randomized IPP (Intensive Prevention Program) and NET-IPP (New Technologies in Intensive Prevention Programs) trials investigate the effects of IPP vs. usual care after acute MI. IPP is performed by cardiovascular prevention assistants that are supervised by physicians and have repetitive contacts to the patients.
The present substudy of the IPP and NET-IPP trials analyzes smoking rates in women compared to men at hospital admission and after 12 months IPP vs. usual care.
Results:
Out of 602 patients with MI and 12-months follow-up, 129 patients (21.4%) were female. Women and men both had a high rate of risk factors, such as physical inactivity or elevated BMI at hospital admission; however, in women a significantly elevated rate of smoking was observed (women 51.9% vs. men 41.2%, p=0.04) (Table 1).
Table 1: Clinical data and risk factor profile at admission in 602 patients with MI; comparison of women vs. men
During 12 months IPP reduced the rate of smoking in women from 54.8% to 4.8%. This reduction was significantly larger than in men that received IPP (38.8% vs. 11.4%, p<0.05 women vs. men) as well as in women that received usual care (49.3% vs. 20.9%. p<0.05 IPP vs. usual care) (Figure 1).
Figure 1: Smoking rates in women vs. men with MI at admission and after 12 months, comparison of IPP vs. usual Care
Conclusions:
At hospital admission for acute MI women presented with higher rates of smoking than men. This finding supports previous data that reported more detrimental cardiovascular effects of smoking in women compared to men.
A 12-months IPP after MI was very effective to reduce the high smoking rates in women.
The study shows that preventive efforts to reduce smoking rates in women are crucially needed - in general population as well as after coronary events.