Tobacco-related cardiovascular risk in women: New issues and therapeutic perspectives

Background. - Smoking is the main modifiable risk factor for stroke and myocardial infarction, particularly in women; its prevalence in France is evolving, and new patterns of nicotine consumption have emerged. Aims. - To present contemporary data on smoking prevalence and the use of electronic cigarettes, and to describe current knowledge of the cardiovascular risk specificities and the effectiveness of withdrawal methods in women. Method. - We identified studies by searching the MEDLINE bibliographic database between 1995 and 2020, and the Weekly Epidemiological Bulletin (Bulletin Epidemiologique Hebdomadaire) published by the French health authorities. Result. - In recent years, smoking prevalence among French women has decreased overall, except in the oldest age group (aged > 55 years). At the same time, the incidence of hospitalization for cardiovascular events has increased worryingly among women smokers aged < 65 years. Active smoking in women is associated with an increased risk of premature myocardial infarction, and a risk of stroke that increases with the number of cigarettes consumed per day; it is also responsible for increased cardiovascular events in women taking oestrogen-progestin contraception. Quitting smoking reverses these effects in the long term, and women are just as likely to quit smoking as men. Conclusions. - Stopping smoking must be a priority objective for women smokers, for primary and secondary prevention, and they should systematically be offered a validated method of cessation or even electronic cigarettes. (c) 2021 Elsevier Masson SAS. All rights reserved.