Reduced life expectancy after an incident hospital diagnosis of acute myocardial infarction--effects of smoking in women and men.

BACKGROUND: The aim was to investigate possible gender differences in the years of life lost after acute myocardial infarction (MI) and to explore how smoking affects life expectancy in the two genders. METHODS: In the years 1998-2005, 2281 patients (36.8% women) who were discharged from or died in hospital following a diagnosis of MI were included. Survivors were followed for a mean of 8 years. The age of death for each patient was subtracted from the average projected age of death for individuals in the general population with a similar age to the patient at the time of their MI. The effects of gender, smoking, and other risk factors on the years of life lost were analysed. RESULTS: During follow-up, 55% of the patients died. Non-smokers, ex-smokers and current smokers lost 5.4, 6.4 and 10.3 years of life, respectively. Structural equation modeling showed that currently smoking men lost 4.2 more years more than did non-smoking men (P<0.001), and this was mediated through more prematurely occurring MIs. Female current smokers lost 1.9 years more than male current smokers and female ex-smokers lost 1.8 years more than male ex-smokers (both P<0.001). CONCLUSIONS: MI caused a substantial number of years of life lost, with a heavier loss in current smokers than in ex-smokers and non-smokers. The effect was predominantly related to the patient's age at the event. More years of life were lost among smoking women than among smoking men, indicating that smoking is most detrimental for the female gender.

Mortality after myocardial infarction: impact of gender and smoking status.

We have shown previously that smoking causes a first myocardial infarction (MI) to occur significantly more prematurely in women than in men. The aim of the study was to investigate mortality after MI with special emphasis on the impact of smoking and gender. The study included 2,281 consecutive patients (36.8% women) who died or were discharged from a central hospital with a diagnosis of MI from 1998 to 2005; the median follow-up of survivors was 7 years. Death after MI was adjusted for confounders. Mean age for women was 5.8 years older than for men (76.0 vs. 70.2 years) and women were less likely to have been smokers. In-hospital mortality for the first MI was 8.9% for men and 13.3% for women, and total mortality rates for all indexed MI after 7 years were 47% for men and 61% for women. Using Cox regression analysis, with all indexed MIs included, the after-discharge mortality for women was significantly lower than for men (hazard ratio 0.82; 95% confidence interval 0.70-0.96; P = 0.015). Compared with non-smokers, patients who were smokers on admission had significantly increased seven-year mortality after discharge (hazard ratio 1.30; 95% confidence interval 1.03-1.63; P = 0.002). In conclusion, current smoking at the time of the indexed MI was associated with increased mortality after 7 years follow-up. The smoking effect was independent of gender. Female gender was associated with a moderately lower risk of death during the same follow-up period.