European women live longer than men, because of both biological and behavioral advantages, but women's longer lives are not necessarily healthy lives. Studies commented on by Dr Vannuzzo at the ESC Congress 2011, show that due to increase in tobacco and in women, the gender gap is decreasing.

In the European Union (27 countries) the total number of deaths is roughly similar in men and women (in 2009: 2 416 786 men and 2 418 048 women), and trends are also similar, but women die older than men and an interesting way to evaluate the difference is Life Expectancy.

Life Expectancy is the average number of years a person can expect to live, if in the future they experience the current age-specific mortality rates in the population. In 2008 the EU Life Expectancy at birth was 82.4 years in women and 76.4 years in men, a gap of 6 years! There were marked differences among countries, with a Life Expectancy at birth ranging in women from 77.0 years in Bulgaria to 84.8 in France, and in men from 66.3 years in Lithuania to 80.0 in Iceland. A gender gap in Life Expectancy was present in each of the 27 countries, always favoring women, with a minimum of 3.3 years in Iceland and a maximum of 11.3 years in Lithuania.

Considering "Healthy life years at birth" by gender, that is, the number of years that a person at birth is still expected to live in a healthy condition, the average proportion is 85% of healthy years in men and 80% in women.

The difference between Life Expectancy and Healthy Life Years at Birth is called Life Expectancy with Disability. In proportion, Life Expectancy with Disability is worse in women but in absolute terms, life is longer compared to men. Disability accumulates in later life and is due to cardiovascular diseases for about ¼. The main reasons for the gender gap in Life Expectancy are tobacco and alcohol. In a recently published study (Tobacco Control 2011;20:166-168. doi:10.1136/tc.2010.037929), smoking-related deaths accounted for around 40% of the gender gap in all-cause mortality, while alcohol-related mortality typically accounted for 20% of the gender gap in Eastern Europe and 10% elsewhere in Europe.

Unfortunately, more and more women smoke and therefore the gender gap is decreasing, like in Italy. Smoking is particularly harmful in women, and its predictive power is higher in women: about 25% in excess, as demonstrated in the Italian Progetto CUORE (Am J Epid 2006; 163(10): 893-902; Europ J Cardiov Prev 2006; 13: 562-570) and in a Lancet Meta-analysis just published (Published Online August 11, 2011 DOI:10.1016/S0140-6736(11)60781-2).