Smoking Status and Functional Outcomes in Young Stroke

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Stroke in young adults is rare, with distinct etiologies and risk factors compared to older populations.
• The 'smoker's paradox' suggests a potentially favorable outcome for smokers, often attributed to age differences.
• Investigating this phenomenon in young stroke patients is crucial for understanding disease mechanisms and risk stratification.

Purpose of the Study:

• To investigate the existence of the smoker's paradox in young stroke patients.
• To compare mortality and functional outcomes between young smokers and non-smokers after stroke.
• To identify specific risk factors and outcomes associated with smoking in this demographic.

Main Methods:

• Analysis of 9,087 young stroke cases from Taiwan's national registry (2006-2016).
• Smoking defined as >1 cigarette/day for >6 months.
• Cox proportional hazards models used for comparing outcomes between smokers and non-smokers after matching for sex and age.

Main Results:

• Smokers were associated with older age, higher comorbidities, and greater alcohol consumption.
• Patients with smoking history and NIH Stroke Scale scores of 11-15 showed worse functional outcomes (aOR 0.81; 95% CI 0.76-0.87).
• The smoker's paradox was not observed; smoking correlated with poorer functional recovery.

Conclusions:

• Young adult smokers face a higher risk of unfavorable functional outcomes 3 months post-stroke.
• These findings contradict the smoker's paradox in this age group.
• Strongly advocate for smoking cessation to improve stroke recovery in young adults.