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Synergistic Effect of Hypertension and Smoking on Ischemic Stroke Risk: A Case-Control Study With Additive and
Jiaqi Wu1, Yaru Li2, Haoran Chen3
1Hebei North University Graduate School; Department of Neurology, Hebei General Hospital.
Journal of Visualized Experiments : Jove
|July 13, 2026
Summary
Smoking and heavy alcohol consumption increase ischemic stroke risk. Hypertension and smoking interact significantly, highlighting the need for integrated prevention strategies targeting these combined risk factors.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Epidemiology
Background:
- Ischemic stroke is a major global cause of death and disability.
- Understanding modifiable risk factors is crucial for effective prevention.
- Traditional cardiovascular risk factors and lifestyle choices like smoking and alcohol consumption play significant roles.
Purpose of the Study:
- To evaluate the independent and interactive effects of smoking, alcohol consumption, and cardiovascular risk factors on first-ever ischemic stroke.
- To identify specific risk factor combinations that elevate stroke risk.
- To inform targeted public health interventions for stroke prevention.
Main Methods:
- Single-center retrospective case-control study.
- Matched 312 cases of first-ever ischemic stroke with 624 controls by age and sex.
- Assessed smoking status, alcohol intake, hypertension, diabetes mellitus, and lipid variables.
- Utilized conditional logistic regression, Firth's penalization, and multiple imputation for analysis.
Main Results:
- Current smoking, heavy alcohol consumption, hypertension, and diabetes mellitus were independently associated with increased ischemic stroke risk.
- Significant interaction was found between hypertension and current smoking on both multiplicative and additive scales.
- The model demonstrated good predictive discrimination (AUC 0.82).
Conclusions:
- Hypertension and smoking act synergistically to increase ischemic stroke risk.
- Integrated prevention strategies addressing coexisting hypertension and smoking are recommended.
- Public health efforts should focus on comprehensive risk factor management to reduce stroke incidence.
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