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Smoking increases risk for acute STEMI in all ages
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Smoking was associated with increased risk for acute STEMI, with a higher rate of incidence in current smokers compared with non- and ex-smokers, according to new data.
The effect was most pronounced in individuals younger than 50 years, researchers found.
“There remains uncertainty as to the magnitude of the effect of tobacco smoking on the younger smoker,” Amelia Lloyd, MD, of the University of Sheffield, England, and colleagues wrote. “No study has compared the incidence of STEMI within young smokers and young non-smokers by using local population data as a denominator.”
Lloyd and colleagues used case data from South Yorkshire Cardiothoracic Centre in Sheffield for patients aged 18 years or older who had undergone PCI for acute STEMI between January 2009 and April 2012. Control data was from the Office for National Statistics’ Integrated Household Survey, which pulled data about South Yorkshire residents aged 18 years or older from April 2009 to March 2012.
Participants were categorized as current smokers, ex-smokers or never smokers.
For the STEMI cohort (n = 1,795; mean age, 63 years; 73% men), 48.5% were current smokers. The mean age of the current smokers was 57 years, younger than ex-smokers (68 years) and never smokers (67 years).
For all ages, current smokers were at a 3.26-fold (95% CI, 2.98-3.57) increased risk for acute STEMI compared with the combination group of ex-smokers and never smokers. When adjusted for age, smokers younger than 50 years were 8.47 (95% CI, 6.8-10.54) times more likely to have acute STEMI. Less pronounced risk differences were seen in those aged 50 to 65 years (RR = 5.2; 95% CI, 4.76-5.69) and for those older than 65 years (RR = 3.1; 95% CI, 2.67-3.6).
According to the researchers, current smokers with acute STEMI peaked in the 60- to 69-year age group, with an incidence rate of more than 350 cases per 100,000 patient-years at risk. For ex- and never smokers with acute STEMI, the peak was in the 70- to 79-year age group, with more than 100 cases per 100,000 patient-years at risk.
Lloyd and colleagues also found that current smokers were more likely than never smokers to have peripheral vascular disease (OR = 3.44; 95% CI, 1.56-7.59).
“The high RR seen in the youngest smokers may indicate that smoking is perhaps the most powerful of all risk factors, exerting its effect much sooner than any other,” the researchers wrote. “This is supported by other studies, which identified smoking as not only the most prevalent risk factor, but also one of the most important in the young.”
In an accompanying editorial, Yaron Arbel, MD, director of the Cardiovascular Research Center, cardiology department, Tel Aviv Medical Center, Israel, wrote: “Our societies should play a more active role in preventing and treating smoking habits in the general population. These should include medical, legislative, commercial and educational efforts. Without all these efforts, we will not reduce the risks associated with smoking.” – by Cassie Homer
Disclosure: The researchers and Arbel report no relevant financial disclosures.
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