Smoking and gender.

Smoking is a major cause of coronary heart disease for both men and women and a positive correlation between tobacco use and cerebrovascular disease has been also described. In addition, cigarette smoking is the most powerful risk factor predisposing to atherosclerotic peripheral artery disease. More recently, passive smoking has been also shown to represent an important risk factor for coronary artery disease. Moreover, the incidence of coronary artery and cerebrovascular diseases in ex-smokers consistently decreases after cessation, further underlying the relevance of smoking as a risk factor for these pathological conditions. The effects of cigarette smoking on atherosclerosis initiation and progression as well on its complications are mostly responsible for the enhanced cardio- and cerebrovascular risk observed in smoking compared to non-smoking subjects. Since hormonal status may also play a role in the development and stability of the atherosclerotic plaque, smoking habits could influence the clinical complications of atheroclerosis in a gender dependent manner. Up to now, however, few studies have investigated the relative importance of smoking as a risk factor for fatal and non-fatal diseases in the two sexes within the same study population. On the basis of available clinical data, this review will discuss the risk of fatal and non-fatal diseases among smoking men and women with special emphasis on cardiovascular and cerebrovascular disease which also represents the most common cause of death among smokers. A description of the mechanisms involved in the tobacco-induced atherosclerotic damage will be also given in order to underline possible gender-related differences.