Introduction:
Cardiovascular disease is the leading cause of mortality worldwide, showing a strong causal association with tobacco use. The aim of this study was to ascertain the influence of cardiovascular risk factors (CVRF), paying special attention to tobacco use, on cardiovascular events, in the general adult population of Cantabria (Spain) and to assess differences by sex

Material and Methods:
A descriptive cross-sectional study nested in a population-based cohort, including men >50 years and postmenopausal women. Cardiovascular risk, cardiovascular events, tobacco consumption and clinical variables related to CVRF were analysed using bivariate analysis. Two multiple regression models were estimated for both sexes with cardiovascular event being the dependent variable.

Results:
We analysed 403 patients (mean age 62,8±10,9 years; 46,2% men). More men than women had ever been smokers (74,2% vs. 34,6%; p=0,0001), and smoking was associated with the consumption of alcohol in men and with coffee in women. Cardiovascular risk was higher in men (5,4% vs. 2,4%; p=0,0001). Global prevalence of cardiovascular event was 10,2%, higher in men (15,1% vs. 6,0%; p=0,008). In multivariate analysis, cardiovascular event was independently associated with smoking in men [adjusted OR=4,58 (95%CI 1,01-20,65); p=0,04], age, hypertension and dyslipidaemia. In women hypertension was the only significant variable after adjusting for confounders.

Conclusions:
The fact that the cardiovascular toxicity attributable to smoking is more delayed in women than in men offers a window of opportunity for early intervention in women. Additionally, since smoking patterns in younger women are similar to those in men, these preventive interventions are more compelling in premenopausal women in order to decrease their cardiovascular risk.