Smokers fare worse after stroke

Smokers fare worse after stroke
Smokers fare worse after stroke

HealthDay News -- Current or ex-smokers who experience a stroke are at greater risk for recurrent vascular events or death in the 10 year period after the event compared with stroke patients who never smoked, study results suggest.

The hazard ratio for death, MI, or recurrent stroke among patients who were current smokers when they had a stroke was 1.30 (95% CI 1.06 to 1.60) compared with individuals who never smoked, Amanda Thrift, PhD, of Monash University in Melbourne, Australia, and colleagues, reported in Stroke: Journal of the American Stroke Association.

Ex-smokers are also at risk, albeit the risk is slightly smaller, according to the researchers. After excluding patients that died within 28 days after the stroke, risk for death, MI or recurrent stroke was elevated in patients who were both current (HR 1.42, 95% CI 1.13 to 1.78) and ex-smokers (HR 1.18, 95% CI 1.01 to 1.39) at the time of their stroke. Overall, current smokers and ex-smokers were younger than those who had never smoked, the researcher added.

"Our finding is important as it provides further evidence of the poor outcome among those who smoke," they wrote. "Because of the potential years of healthy life that is lost, smoking will indirectly be making a major contribution to the costs of stroke."

Although previous studies have shown that smokers have poorer prognosis after MI than nonsmokers, research is limited on how smoking status affects long-term outcomes after stroke is limited. So Thrift and colleagues examined the association between smoking and the risk for death, recurrent stroke and MI in 1,589 patients who participated in the North East Melbourne Stroke Incidence Study (NEMESIS), who had had a first-ever or recurrent stroke from 1997 to 1999.

The researchers recorded all deaths, recurrent strokes and acute MIs, as verified by medical records or death certificates, during the 10 year follow-up period. Overall, 23% died within 28 days of the initial stroke.

Compared with those who had never smoked, current and past smokers were younger, more likely to be male and more likely to be socially disadvantaged, the researchers found. When they looked at stroke subtype, the association between smoking status was found fir ischemic stroke, but not intracerebral hemorrhage; however, this may be due to the small number of study participants that experienced hemorrhage.

"People with stroke who are younger, or male, or living in more disadvantaged areas are likely to be smokers and these groups should be targeted for smoking cessation for primary prevention of stroke," the researchers concluded.

References

  1. Kim J et al. Stroke 2012; doi: 10.1161/STROKEAHA.112.668905.
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