Associations between Smoking and Major Adverse Cardiac Events in Women
Authors:Rosa Ahn, Sasha Brietzke, Debbie Yan Qun Huang
- Tanya Kenkre, Statistician, University of Pittsburgh, Epidemiology Data Center
- Maria Brooks, Epidemiology Professor, University of Pittsburgh, Epidemiology Data Center
- Roslyn Stone, Biostatistics Professor, University of Pittsburgh
A primary goal of the Women’s Ischemia Syndrome Evaluation (WISE) study is to better understand the pathophysiology of ischemic heart disease (IHD) in women. Smoking is associated with an increased risk of having a major adverse cardiac event (MACE). We investigated whether smoking status is a significant predictor of MACE among participants in the WISE study, who were women with chest pain or suspected myocardial ischemia.
The WISE population consists of 913 women. Demographics, medical history and psychosocial status data were collected at baseline. Symptoms, treatments and cardiovascular events were assessed at baseline and follow-up at 6 weeks and annually thereafter, with a mean follow-up time of 5.9 years. During the study follow-up period, 194 women experienced MACE. We performed F-tests and Chi-square tests to assess differences between non-smokers, former smokers and current smokers at baseline. Log-rank statistics and Cox regression models were used to test for differences in the time to 1st MACE by smoking status.
The Kaplan-Meier survival functions are significantly different among the three smoking groups for MACE, with non-smokers having the lowest risk of an event (P < 0.01). Former smokers and current smokers had hazard ratios (HR) of 2.16 and 2.14 respectively; age (HR = 1.02; P = 0.02), history of a MI (HR = 1.44; P = 0.03), history of depression (HR = 1.60; P < 0.01), history of hypertension (HR = 1.53; P = 0.01), history of CHF (HR = 3.24; P < 0.01), prior alcohol use (HR = 0.53; P = 0.02), and atherosclerosis (HR = 1.85; P < 0.01) are significant predictors of risk of MACE.
Smoking, age, atherosclerosis and history of hypertension, treated depression, MI and CHF each are associated with increased risk of MACE, whereas alcohol use within 6 months of study entry appears to be protective.