How common is smoking in women?
A smoker is anyone who has smoked 100 cigarettes in his or her lifetime and who still smokes one or more cigarettes a day. In the 1970s, smoking levels began to decline in US adults, but in recent years the smoking rate has been declining at a slower rate.1, 2 As of 2005 about 1 in 5 (more than 20 million) women in the US smoke. Nearly 80% of smokers begin before age 18. About 25% of girls in grades 9 through 12 smoke.3
Does smoking increase my risk of developing heart failure?
Yes. Smokers have a higher risk of developing heart failure compared with people who don't smoke.4, 5 Smoking also increases your risk of developing coronary artery disease and having a heart attack, which damages the heart and often leads to heart failure. A study that followed nearly 120,000 women nurses aged 30 to 55 for 12 years found that those who smoked were 3 times more likely to suffer a heart attack or die from heart disease than nonsmokers.6 The risks were even higher for women who started smoking before the age of 15—they were 9 times more likely to suffer heart problems.
The more cigarettes you smoke, the higher your risk of heart failure, but even light smoking is harmful.7 Small studies have found that smoking even a single cigarette causes the heart muscle to temporarily stiffen and fill with less blood.8, 9
How is smoking related to heart failure?
Smoking increases your risk of developing heart failure by placing an added strain on the heart, causing it to work harder to pump blood and potentially damaging the heart muscle over time. There are several ways in which smoking may increase your heart failure risk:
- Smoking increases the heart's demand for oxygen—by raising heart rate and blood pressure—while reducing the heart's supply of oxygen by narrowing the arteries and restricting the flow of oxygen-rich blood to the heart. This forces the heart to work harder to pump enough blood.
- The added strain placed on the heart by smoking eventually damages the heart muscle and causes the heart's main pumping chamber (the left ventricle) to pump less blood than in nonsmokers10 and may also limit its ability to relax and fill with blood.11
- Smoking may cause a heart attack, which can permanently damage the heart muscle and lead to heart failure.
Is smoking more harmful for women than for men?
Smoking appears to have a greater effect on heart failure risk in women than in men. One study of 14,000 adults (59% were women) found that smoking increased the risk of heart failure by 88% in women compared with 45% in men.12
Can I prevent heart failure if I quit smoking?
One of the most important things you can do for your health is to quit smoking. Quitting smoking reduces your risk of developing some of the strongest risk factors for heart failure, such as coronary artery disease and heart attack. A woman's risk of heart disease is cut by one third within 2 years of quitting and about two thirds within 5 years.13 After 15 to 20 cigarette-free years, the risk of coronary artery disease is the same as a woman who never smoked. For women who have already had a heart attack or been diagnosed with heart disease, it is even more important to stop smoking.
To stop smoking may be harder for women than for men. Many women are concerned that they will gain weight if they quit smoking. While you may gain 6 to 12 pounds in the year you quit smoking, bear in mind that most people who continue to smoke will gain weight too. The health risks of smoking far outweigh the risks of gaining some weight. Don't let the fear of gaining a few pounds stop you from quitting smoking and significantly improving your health.
Women also differ from men in how they respond emotionally and physically to smoking cigarettes. Smoking cigarettes improves a woman's mood, making it more difficult for her to quit. Some women report that by quitting smoking after their period, they had less anxiety and irritability due to premenstrual syndrome. Furthermore, women's bodies process nicotine differently, suggesting that nicotine replacement treatment should be tailored differently for women.14
Please see our section on Quitting Smoking for more information and for links to resources that can help you succeed.
Will cutting back lower my heart failure risk?
There is no "safe" number of cigarettes. Just 1 cigarette may cause your heart muscle to slightly stiffen,8, 9 and as few as 1 to 4 cigarettes a day doubles the risk of having a heart attack.15 Moreover, smoking cigarettes with lower yields of tar and nicotine have not been shown to lower your risk of heart disease and should not be considered lower-risk alternatives to regular cigarettes.16
What are the other health risks of smoking?
In addition to increasing your risk of heart disease—including heart failure—smoking also increases your risk of stroke and disease of the blood vessels in your legs (peripheral vascular disease). Smoking puts you at high risk for some cancers, particularly lung cancer, and it is the major cause of breathing problems including emphysema.1 Women who smoke have a higher risk of osteoporosis (bone loss) and they may go through menopause at a younger age than nonsmokers. Smoking is also linked to difficulty getting pregnant and problems during pregnancy, such as having a premature baby. See also: Pregnancy & Smoking
- Women and Smoking: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services Centers for Disease Control and Prevention; 2001.
- Substance Abuse and Mental Health Services Administration--Results from the 2007 National Survey on Drug Use and Health: National findings (Office of Applied Studies). http://www.oas.samhsa.gov/nsduh/2k7nsduh/2k7Results.pdf, 2008.
- Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation . Jan 29 2008;117(4):e25-146.
- Schocken DD, Benjamin EJ, Fonarow GC, et al. Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation . May 13, 2008;117(19):2544-2565.
- Butler J, Kalogeropoulos A, Georgiopoulou V, et al. Incident Heart Failure Prediction in the Elderly: The Health ABC Heart Failure Score. Circ Heart Fail . July 1, 2008;1(2):125-133.
- Willett WC, Hennekens CH, Bain C, Rosner B, Speizer FE. Cigarette smoking and non-fatal myocardial infarction in women. Am J Epidemiol . May 1, 1981;113(5):575-582.
- Shaten BJ, Kuller LH, Neaton JD. Association between baseline risk factors, cigarette smoking, and CHD mortality after 10.5 years. MRFIT Research Group. Prev Med . Sep 1991;20(5):655-659.
- Gembala MI, Ghanem F, Mann CA, Sorrell VL. Acute changes in left ventricular diastolic function: Cigarette smoking versus nicotine gum. Clin Cardiol . February 2006;29(2):61-64.
- Alam M, Samad BA, Wardell J, Andersson E, Hoglund C, Nordlander R. Acute effects of smoking on diastolic function in healthy participants: studies by conventional doppler echocardiography and doppler tissue imaging. J Am Soc Echocardiogr . Oct 2002;15(10 Pt 2):1232-1237.
- Heckbert SR, Post W, Pearson GDN, et al. Traditional Cardiovascular Risk Factors in Relation to Left Ventricular Mass, Volume, and Systolic Function by Cardiac Magnetic Resonance Imaging: The Multiethnic Study of Atherosclerosis. J Am Coll Cardiol . December 5, 2006;48(11):2285-2292.
- Lichodziejewska B, Kurnicka K, Grudzka K, Malysz J, Ciurzynski M, Liszewska-Pfejfer D. Chronic and Acute Effects of Smoking on Left and Right Ventricular Relaxation in Young Healthy Smokers. Chest . April 1, 2007;131(4):1142-1148.
- He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk Factors for Congestive Heart Failure in US Men and Women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med . April 9, 2001;161(7):996-1002.
- Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and Smoking Cessation in Relation to Mortality in Women. JAMA . May 7, 2008;299(17):2037-2047.
- Perkins KA. Smoking cessation in women. Special considerations. CNS Drugs. 2001;15(5):391-411.
- Willett WC, Green A, Stampfer MJ, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med . November 19, 1987;317(21):1303-1309.
- The Health Consequences of Smoking: A Report of The Surgeon General. Washington, D.C.: Dept. of Health and Human Services, Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; May 27 2004.