Persistent smoking linked to risk for CV events, death after acute ischemic stroke
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Key takeaways:
- In patients with acute ischemic stroke, persistent smoking conferred elevated risk for CV events and death vs. never smoking.
- Former smokers and those who quit after their stroke did not have elevated risk.
Smoking consistently after acute ischemic stroke was associated with increased risk for CV events and death compared with never smoking, researchers reported.
“In this study, we demonstrated an association between persistent smoking after stroke and higher risk of composite outcome of death, stroke and myocardial infarction. In addition, persistent smokers had double the risk of death compared to never smokers,” Mohammad Anadani, MD, of the department of neurosurgery at the Medical University of South Carolina, and colleagues wrote. “Interestingly, there was no significant difference in the risk of cardiovascular events or death between patients who were former smokers at baseline or those who quit smoking compared to never smokers, which implies that smoking cessation after stroke may reduce the risk of death and cardiovascular events.”
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A total of 2,874 individuals with acute ischemic stroke were included in the post hoc analysis of Secondary Prevention of Small Subcortical Strokes (SPS3), a randomized, multicenter trial conducted in 82 centers between March 2003 and April 2011 in Spain, North America and Latin America. The primary outcome was major adverse CV events, defined as stroke, MI and mortality, at 18 months, according to the study. Secondary outcomes included stroke, MI and death as individual outcomes. Outcomes were adjusted after the third month of enrollment until an outcome event or the end of the study follow-up.
Individuals were stratified based on smoking status: never smokers, former smokers, smokers who quit at 3 months and persistent smokers. Of those included, 570 individuals (20%) were smokers when enrolled, of whom 408 (71.5%) continued smoking and 162 (28.4%) quit smoking by 3 months, the researchers wrote. Smoking status was assessed at baseline, 3 months and every 3 months following.
The researchers found that 28.4% of smokers at baseline quit at 3 months and 34% quit at 18 months, whereas of those who quit smoking by 3 months, 14.2% had resumed smoking by 6 months and 20.4% had resumed by 12 months.
A major adverse CV event occurred in 18.4% of persistent smokers, 12.4% of smokers who quit, 16.2% of prior smokers and 14.4% of never smokers at 18 months. After adjustment for age, sex, race, ethnicity, education, employment history, hypertension, diabetes, MI, hyperlipidemia and randomization arm of the trial, risk for the primary outcome was higher in persistent smokers compared with never smokers (adjusted HR = 1.56; 95% CI, 1.16-2.09), whereas those who quit smoking by 3 months did not have significantly different risk for the primary outcome compared with never smokers (aHR = 1.25; 95% CI, 0.77-2.02), according to the study.
“Persistent smoking compared to never smoking after lacunar stroke was associated with a significant increase in the risk of major cardiovascular events and death,” Anadani and colleagues wrote. “The overall rate of smoking cessation after ischemic stroke was low, highlighting the need for more targeted and effective smoking cessation strategies.”
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