Dose-dependent neurotoxic impact of cigarette smoking on post-stroke survival

Cigarette smoking is a significant risk factor for stroke. However, there is no consistent association between baseline smoking and post-stroke mortality. The aim of this investigation was to identify the effect of cigarette smoking on short-term outcomes of stroke survivors registered in the Tabriz Stroke Registry.

A prospective cohort study was performed on patients with stroke registered at the Tabriz Stroke Registry (TSR) over seven years, from 2014 to 2021. Two groups were compared: current cigarette smokers (≥1 cigarette/day) and non-smokers. The World Health Organization (WHO) criteria were used to define stroke. Data were collected on demographic information, clinical features, imaging and lab findings, exposure to risk factors, indicators of stroke severity, drug history, complication, and medications. In-hospital mortality was the primary outcome of the current study. Patients were categorized based on their smoking status.

The mortality rate in cigarette smokers was 29.1 %, while it was only 10.1 % in non-smokers. Patients who were current smokers had an increased risk of post-stroke mortality in comparison to non-smokers (Hazard Ratio = 4.3, 95% CI = 3.6, 5.2) (P-value < 0.001). Hazard of post-stroke mortality in light smoker was 1.6 (95 % CI = 0.9, 2.8, P-value = 0.087) times higher than non-smokers, while it increased to 4.5 (95% CI = 3.6, 5.6, P-value < 0.001) and 21.6 (95 % CI = 15.9, 29.5, P-value < 0.001) in heavy (11-20 cigarettes smoke per day) and very smokers (>20 cigarette per day), respectively.

In this study, current cigarette smoking was found to be an independent risk factor for post-stroke mortality with a dose dependent pattern. By quantifying the dose‑related mortality risk among post‑stroke smokers, this study reinforces the importance of integrating targeted risk assessment, patient‑specific education, and structured smoking cessation interventions within vascular nursing practice to improve survival outcomes in this high‑risk population.