Smokers at Higher Risk of Another Stroke: Study

Quitting before brain attack occurs cuts chances of second stroke, heart attack or death

Thursday, October 25, 2012

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THURSDAY, Oct. 25 (HealthDay News) -- People who are smokers at the time of their first stroke have a greater risk of another stroke, heart attack or death than those who never smoked, according to a study by Australian researchers.
And those who quit smoking before their stroke had a lower risk than those who were still smoking when they had a stroke, the researchers noted.
"Smokers are more likely to do badly after a stroke," said lead researcher Amanda Thrift, a professor of epidemiology at Monash University.
Ex-smokers, however, fared much better, she said.
"Stop smoking, because one of the things we showed is that people who gave up smoking had a much greater benefit than those who were still smoking," Thrift said. "There are real benefits to be gained from giving up smoking."
The report was published in the Oct. 25 online edition of the journal Stroke.
For the study, Thrift's team collected data on more than 1,500 stroke survivors who had a stroke between 1996 and 1999.
After 10 years of follow-up, the investigators found that those who were smokers when they had their stroke were 30 percent more likely to have another stroke, heart attack or die, compared to those who never smoked. These risks were particularly significant among younger stroke patients.
Smokers who survived the first 28 days after their stroke had a 42 percent increased risk of these outcomes, the researchers found. For those who had quit smoking before their stroke, difference in risk dropped to 18 percent.
Comparing only current smokers and former smokers, of those who survived the first four weeks after a stroke, those who were still smoking at the time of their stroke had a 23 percent higher risk of a recurring stroke, heart attack or death within the next 10 years.
These findings were further skewed by poverty, with a 52 percent increased risk of a poor outcome among smokers living in the most disadvantaged areas and 31 percent increased risk among those who never smoked, Thrift's group found.
Most patients in the study suffered the most common type of stroke, one in which a blood clot blocks a blood vessel in the brain -- called an ischemic stroke.
Thrift noted that there weren't enough people in the study who suffered a hemorrhagic stroke, one caused by bleeding in the brain, to draw any conclusion about smoking and those outcomes.
Commenting on the report, an expert who was not involved with the study, Dr. Rafael Ortiz, described the physical connection between smoking and cardiovascular disease.
"Smoking predisposes people to hardening of the arteries and stroke," said Ortiz, director of the Center for Stroke and Neuro-Endovascular Surgery at Lenox Hill Hospital in New York City.
This is the result of nicotine and carbon monoxide's effect on the blood vessels, he added.
"Never start smoking," Ortiz advised. "If you're a current smoker, stop, because it predisposes you to having a stroke and if you have a stroke it will have a worse outcome and it predisposes you to have a stroke at an earlier age."
Patricia Folan, director of the Center for Tobacco Control at the North Shore-LIJ Health System in Great Neck, N.Y., echoed Thrift's and Ortiz's advice.
"Quit smoking," Folan said.
Smokers have a great deal of disability after a stroke and a decreased quality of life, she said. People may not die after a stroke, but they may not be able to move or communicate and "their quality of life will be poor," she said.
"If we can convince people that smoking is going to have a big impact not only in their life span, but also in their quality of life in terms of not having a stroke or heart attack, that's the most important message," Folan said.

SOURCES: Amanda Thrift, Ph.D., professor of epidemiology, Monash University, Clayton, Australia; Patricia Folan, director, Center for Tobacco Control, North Shore-LIJ Health System, Great Neck, N.Y.; Rafael Ortiz, M.D., director, Center for Stroke and Neuro-Endovascular Surgery, Lenox Hill Hospital, New York City; Oct. 25, 2012, Stroke, online

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