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. 2010 Apr 30;33(6):E49–E54. doi: 10.1002/clc.20716

Comparison of Traditional Risk Factors, Angiographic Findings, and In‐Hospital Mortality between Smoking and Nonsmoking Turkish Men and Women With Acute Myocardial Infarction

Nazif Aygul 1,✉, Kurtulus Ozdemir 2, Adnan Abaci 3, Meryem Ulku Aygul 2, Mehmet Akif Duzenli 2, Huseyin Ugur Yazici 3, Ibrahim Ozdogru 4, Ekrem Karakaya 4
PMCID: PMC6653313  PMID: 20552593

Abstract

Background

The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey.

Hypothesis

The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI.

Methods

This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in‐hospital outcome were recorded.

Results

The proportion of male smokers was significantly higher than that of women (68% vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had less multivessel disease and less comorbidity as compared to nonsmokers. Although the in‐hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality.

Conclusions

Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI between men and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking. Copyright © 2010 Wiley Periodicals, Inc.

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References

  • 1.World Health Organization. The World Health Report 2002—Reducing risks to health, promoting healthy life. Available at: URL: http://www.who.int/whr/2002/en/index.html. [DOI] [PubMed]
  • 2. Steingart RM, Packer M, Hamm P, et al. Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators. N Engl J Med 1991; 325(4): 226–230. [DOI] [PubMed] [Google Scholar]
  • 3. Shaw LJ, Miller DD, Romeis JC, et al. Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med 1994; 120(7): 559–566. [DOI] [PubMed] [Google Scholar]
  • 4. Bowling A, Bond M, McKee D, et al. Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications. Heart 2001; 85(6): 680–686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Shaw LJ, Bairey Merz CN, Pepine CJ, et al; WISE Investigators. Insights from the NHLBI‐Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender‐optimized diagnostic strategies. J Am Coll Cardiol 2006; 47(suppl 3): S4–S20. [DOI] [PubMed] [Google Scholar]
  • 6. Bairey Merz CN, Shaw LJ, Reis SE, et al; WISE Investigators. Insights from the NHLBI‐Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender‐based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol 2006; 47(suppl 3): S21–29. [DOI] [PubMed] [Google Scholar]
  • 7. Gerber Y, Weston SA, Killian JM, et al. Sex and classic risk factors after myocardial infarction: a community study. Am Heart J 2006; 152(3): 461–468. [DOI] [PubMed] [Google Scholar]
  • 8. Tokgözoglu L, Baris Kaya E. Atherosclerotic vascular disease and risk factors in Turkey: from past to present. J Atheroscler Thromb 2008; 15(6): 286–291. [DOI] [PubMed] [Google Scholar]
  • 9. Yusuf S, Hawken S, Ounpuu S, et al; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case‐control study. Lancet 2004; 364(9438): 937–952. [DOI] [PubMed] [Google Scholar]
  • 10. Heidemann C, Hoffmann K, Klipstein‐Grobusch K, et al. Potentially modifiable classic risk factors and their impact on incident myocardial infarction: results from the EPIC‐Potsdam study. Eur J Cardiovasc Prev Rehabil 2007; 14(1): 65–71. [DOI] [PubMed] [Google Scholar]
  • 11. Hodoglugil U, Mahley RW. Smoking and obesity make a bad problem worse: genetics and lifestyle affect high density lipoprotein levels in Turks. Anadolu Kardiyol Derg 2006; 6(1): 60–66. [PubMed] [Google Scholar]
  • 12. Onat A, Aksu H, Uslu N, et al. Smoking among Turkish adults: rising trend in women. Turk Kardiyol Dern Ars (in Turkish). 1999; 27(10): 697–700. [Google Scholar]
  • 13. Aygul N, Ozdemir K, Abaci A, et al. Prevalence of risk factors of ST segment elevation myocardial infarction in Turkish patients living in Central Anatolia. Anadolu Kardiyol Derg 2009; 9(1): 3–8. [PubMed] [Google Scholar]
  • 14. Satman I, Yilmaz T, Sengül A, et al. Population‐based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002; 25(9): 1551–1556. [DOI] [PubMed] [Google Scholar]
  • 15.The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/ American College of Cardiology Committee for the Redefinition of Myocardial Infarction. Eur Heart J 2000; 21(18): 1502–1513. [DOI] [PubMed] [Google Scholar]
  • 16. Chobanian AV, Bakris GL, Black HR, et al; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42(6): 1206–1252. [DOI] [PubMed] [Google Scholar]
  • 17.The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20(7): 1183–1197. [DOI] [PubMed] [Google Scholar]
  • 18. Maron DJ, Ridker PM, Pearson TA, et al. Dyslipidemia, other risk factors, and the prevention of coronary artery disease In: Fuster V, Alexander RW, O'Rourke RA. eds. Hurst's The Heart, New York McGraw‐Hill Publishers; 2001; 1131. [Google Scholar]
  • 19. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma, without the use of preparative ultracentrifuge. Clin Chem 1972; 18(6): 499–501. [PubMed] [Google Scholar]
  • 20.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002; 106(25): 3143–3421. [PubMed] [Google Scholar]
  • 21. Gensini GG. Coronary Arteriography. Mount Kisco, New York: Futura Publishers; 1975. [Google Scholar]
  • 22. Peto R, Lopez AD, Boreham J, et al. Mortality from smoking worldwide. Br Med Bull 1996; 52(1): 12–21. [DOI] [PubMed] [Google Scholar]
  • 23. Greenland P, Knoll MD, Stamler J, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290(7): 891–897. [DOI] [PubMed] [Google Scholar]
  • 24. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290(7): 898–904. [DOI] [PubMed] [Google Scholar]
  • 25. Prugger C, Wellmann J, Heidrich J, et al. Cardiovascular risk factors and mortality in patients with coronary heart disease. Eur J Epidemiol 2008; 23(11): 731–737. [DOI] [PubMed] [Google Scholar]
  • 26. Teo KK, Ounpuu S, Hawken S, et al; INTERHEART Study Investigators. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case‐control study. Lancet 2006; 368(9536): 647–658. [DOI] [PubMed] [Google Scholar]
  • 27. Newby DE, Wright RA, Labinjoh C, et al. Endothelial dysfunction, impaired endogenous fibrinolysis, and cigarette smoking: a mechanism for arterial thrombosis and myocardial infarction. Circulation 1999; 99(11): 1411–1415. [DOI] [PubMed] [Google Scholar]
  • 28. Gullu H, Caliskan M, Ciftci O, et al. Light cigarette smoking impairs coronary microvascular functions as severely as smoking regular cigarettes. Heart 2007; 93(10): 1274–1277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004; 43(10): 1731–1737. [DOI] [PubMed] [Google Scholar]
  • 30. Yildirim N, Arat N, Doǧan MS, et al. Comparison of traditional risk factors, natural history and angiographic findings between coronary heart disease patients with age < 40 and ≥ 40 years old. Anadolu Kardiyol Derg 2007; 7(2): 124–127. [PubMed] [Google Scholar]
  • 31. Ishihara M, Sato H, Tateishi H, et al. Clinical implications of cigarette smoking in acute myocardial infarction: acute angiographic findings and long‐term prognosis. Am Heart J 1997; 134(5 Pt 1): 955–960. [DOI] [PubMed] [Google Scholar]
  • 32. Angeja BG, Kermgard S, Chen MS, et al. The smoker's paradox: insights from the angiographic substudies of the TIMI trials. J Thromb Thrombolysis 2002; 13(3): 133–139. [DOI] [PubMed] [Google Scholar]
  • 33. Himbert D, Klutman M, Steg G, et al; the GRACE Investigators. Cigarette smoking and acute coronary syndromes: a multinational observational study. Int J Cardiol 2005; 100(1): 109–117. [DOI] [PubMed] [Google Scholar]
  • 34. Gourlay SG, Rundle AC, Barron HV. Smoking and mortality following acute myocardial infarction: results from the National Registry of Myocardial Infarction 2 (NRMI 2). Nicotine Tob Res 2002; 4(1): 101–107. [DOI] [PubMed] [Google Scholar]

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