Female smokers at greater risk of heart attacks, finds study

According to a large population study from the United Kingdom, women who smoke or those who have high blood pressure or diabetes are at a greater risk of heart attacks than men with same risks. The study results were published in the latest issue of the journal British Medical Journal.

Image Credit: PHILIPIMAGE / Shutterstock
Image Credit: PHILIPIMAGE / Shutterstock

The researchers from Oxford University have said that women should be offered support to help them quit smoking as they may be at greater risk than men. They also add that physicians need to be aware of the risks to women and spot females who are at risk of heart disease.

The team of researchers looked at data from 471,998 individuals aged between 40 and 69 years from the UK Biobank database (56 percent of the population were women). The population was tracked for an average of seven years during which 5,081 individuals had their first heart attack. One third of these individuals were females. Results showed –

  • The researchers explain that the overall risk of heart attacks is still greater among men but women who smoked were three times more likely to have a heart attack compared to women who did not smoke.
  • Men who smoked were twice as likely to get heart attacks compared to men who did not smoke.
  • Women who smoked were at a 55 percent greater risk of getting a heart attack compared to men, the results showed.
  • Women who smoked were at a 246 percent more risk of getting a heart attack while men who smoked were at a 123 percent greater risk of getting a heart attack.
  • Women with hypertension or high blood pressure were an 83 percent higher risk of getting heart attacks compared to men.
  • Both type 1 and type 2 diabetes raised the risk of heart attacks by 47 percent extra in women than in men, found the study.

According to the researchers, the exact reason why these women with the specific three risk factors were at greater risk than men was not known. However they speculated that women with type 2 diabetes are likely to have an unhealthy lifestyle and poor diet and exercise patterns. This may affect their hearts worse than male hearts, they explain. The way women’s bodies store fat could provide another clue as to why they are at a greater risk.

Dr Sanne Peters, co-author of the study said that women on an average are more “pear-shaped” while men are more “apple-shaped”. This difference in fat storage could affect the metabolic system differently and may show sex differences in diabetes prevalence.

The researchers also point out that women might be getting poorer care and treatment from healthcare facilities and their heart conditions might be missed largely because of their perceived lower risk of heart disease than men. Studies have shown that women are 15 percent less likely to be treated same as men for diabetes in UK.

Women need to be treated as per protocol for diabetes and hypertension similar to men, say the researchers. According to lead researchers Dr Elizabeth Millett, an epidemiologist at the George Institute for Global Health, University of Oxford, “Heart disease also affects women and this needs to be recognised.

Women need to be aware they're at risk, but despite lots of campaigns, it's still under the radar of most women. It's a complicated, long-term thing to work out, probably caused by a combination of factors - both biological and social.” She said that the major focus was on breast cancer in women now.

The British Heart Foundation also says that women are less likely to seek medical help and treatment for heart conditions despite having warning symptoms. Professor Metin Avkiran, of the British Heart Foundation in a statement said, “This is an important reminder that heart disease does not discriminate, so we must shift perceptions that it only affects men.”

In an accompanying editorial with the article, experts have said that men may be more at risk of heart attacks but women are more likely to die from heart attacks than men in UK. According to Millett, soon women may be having same number of heart attacks as women with the rise in the ageing population.

The authors of the study concluded, women with diabetes, high blood pressure and those who smoke, “should be considered at a level of risk comparable to many men.”


'Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants' - BMJ 2018;363:k4247 https://doi.org/10.1136/bmj.k4247

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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