Stroke survivors who smoke raise risk of more strokes, heart attack, death

Those who quit smoking before their stroke also had less risk of poorer outcomes than current smokers, researchers found.

Researchers in Melbourne, Australia, tracked 1,589 patients who experienced a first or recurrent stroke in 1996-99. They followed them for 10 years, using medical records and in-person and telephone interviews, and tracked demographics, deaths, recurrent strokes and heart attacks.

Compared to those who never smoked:

• Those who smoked when they had a stroke were 30 percent more likely to have a poor outcome.
• Among those who survived the first 28 days after stroke, current smokers had a 42 percent higher risk of poorer outcomes.
• Ex-smokers had an 18 percent higher risk of poorer outcomes.

Compared to past smokers:

• Among those who survived the first 28 days after stroke, current smokers had a 23 percent higher risk of poorer outcomes during the 10 years.

"This research provides fresh incentive to quit smoking now or never start because it shows smokers fare far worse after strokes than non-smokers," said Amanda Thrift, Ph.D., the study's lead researcher and professor of epidemiology for the Department of Medicine in the Southern Clinical School at Monash University in Clayton, Victoria, Australia.

In the study, those living in disadvantaged areas were much more likely to smoke, with 52 percent of current smokers belonging to the most disadvantaged group, compared to 31 percent of those who never smoked.

"We also found smoking had its greatest impact on younger patients," Thrift said. "The people who smoked in our study were younger, more often male, and more often from a disadvantaged background. Although we want everyone to give up smoking, targeting this group could yield greater benefits with fewer dollars spent."

The study focused on patients who survived the most common type of stroke: an ischemic stroke (caused by blood clot). Researchers didn't link smoking to poorer long-term outcomes for patients whose stroke was caused by bleeding within the brain (intracerebral hemorrhage ), possibly due to a small sample size.

Previous studies, which have been shorter, had a smaller sample size or were less comprehensive, have provided inconsistent results on smoking's role on long-term outcomes after a stroke.

Stroke is the fourth-leading cause of death and the leading cause of adult disability in the United States. Someone in America has a stroke about every 40 seconds.

Co-authors are Joosup Kim, BBiomedSci; Seana Gall, Ph.D.; Helen Dewey, Ph.D.; Richard Macdonell, M.D.; and Jonathan Sturm, Ph.D. Author disclosures are on the manuscript.

The National Health and Medical Research Council, Victorian Health Promotion Foundation, Foundation for High Blood Pressure Research and the National Stroke Foundation funded the study.