Female smoking: an important and earliest impact cardiovascular men

Among the cardiovascular risk factors, smoking is one whose prevalence (total number of cases per year) has changed the most in women becoming the dominant risk factor for premenopausal women and one to which should primarily be directed prevention efforts, warns Professor Daniel Thomas (Pitié-Salpêtrière, Paris)

Cardiovascular disease associated

Between 1980 and 2000, the number of smokers aged over 15 years increased from 17% to 21% among women (INSEE data) and 18-19 years, 48.6% of girls are regular smokers (47.4 versus % of boys) in the health barometer INPE 2000, recalls the specialist.

According to him, the relative protection related to hormonal status whose wife has until menopause, do not put away the dangers of smoking. "The mechanisms involved, especially spasm and thrombosis, explain the possibility of early accidents including the absence of visible arterial lesions," he informs.

The risk of smoking among women vis-à-vis coronary artery disease has been well demonstrated by the "Nurses Health Study". This American prospective study evaluated the incidence (number of new cases per year) of coronary artery disease and its correlation with smoking in a population of 119,000 nurses aged 30 to 55 and no signs of coronary artery disease at entry into the study.

"It has been found that the number of cigarettes smoked is positively correlated with the risk of death from coronary heart disease (5.5 times more than 25 cigarettes per day), with the risk of myocardial infarction (multiplied by 5 , 8), as well as the occurrence of angina pectoris (2.6 times), "says Dr. Thomas, adding that the consumption of cigarettes in this age group is responsible for 50% of coronary events.

However, he says, even moderate consumption (between 1 and 15 cigarettes per day) are associated with increased risk. Also in this study, the risk of stroke (stroke) is also increased significantly (2.73 times) and proportionally with the number of cigarettes smoked.

"Moreover, he says, the association smoking and birth control pills significantly increases the risk of myocardial infarction and stroke, especially after 35 years. This combination should therefore be formally recommended" insists cardiologist.

A risk factor for atherosclerosis and thrombogénécité

Smoking causes an impairment of endothelium-dependent vasodilation: this is one of the earliest manifestations of atherosclerosis, even for this low consumption of tobacco, including in the context of passive smoking. It explains the frequency of spastic coronary events in smokers.

In addition, smoking causes an increase in circulating leukocytes and elevated markers of inflammation that contribute to atherogenesis, and a decrease in HDL cholesterol (the "good" cholesterol), the relatively high rate in the women before menopause, is one of the elements of natural protection against atherosclerosis.

"This adverse effect of smoking on HDL cholesterol is even for relatively low consumption, from 6 cigarettes a day," says Professor Thomas.

Finally, the achievement of taste and smell directs smokers to preferential consumption of fat at the expense of fruits and vegetables rich in antioxidants, attitude contributing to an increase in the peroxidation of LDL cholesterol (the "bad" cholesterol ), biochemical reactions known for its highly atherogenic role, says the specialist.

Smoking, he added, represents a powerful thrombogenic factor, related to:

- An increase of the adhesiveness of the aggregation of platelets,

- An increase in fibrinogen,

- A decrease in the physiological fibrinolytic activity,

- An increase in red blood cells and leukocytes in the blood, causing a rise in blood viscosity.

"All of these changes explains the particular frequency of acute thrombotic events, including the arteries, the walls seem to be very little affected. Such accidents can therefore occur in young women '", he says.

In the opinion of the physician, it is now essential that practitioners are involved more systematically in the prevention of smoking among women. Outside the board, even if motivated women and less dependent can theoretically achieve a withdrawal without specific support, it is necessary to propose other appropriate medical assistance, as well as effective monitoring.

"Among the cardiovascular risk factors, smoking is certainly one on which it is most important to act radically and so early," he says.