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Published on: January 16, 2015
Cigarette smoking and stroke in a cohort of U.S. male physicians
A S Robbins1, J E Manson, I M Lee
1Brigham and Women's Hospital, Boston, MA.
Insights
Current cigarette smoking significantly increases stroke risk in men. Former smokers did not show a higher risk, indicating smoking cessation benefits. This study highlights smoking as a major stroke risk factor.
Area of Science:
- Epidemiology
- Cardiovascular Disease Research
- Public Health
Background:
- Cigarette smoking is a known risk factor for cardiovascular diseases.
- Understanding the specific impact of smoking on stroke risk is crucial for public health interventions.
Purpose of the Study:
- To investigate the association between cigarette smoking and the risk of experiencing a stroke in men.
- To differentiate the stroke risk associated with current versus former smoking habits.
Main Methods:
- A prospective cohort study design was employed.
- 22,071 male physicians aged 40-84 were followed for an average of 9.7 years.
- Participants were categorized as never-smokers, current smokers (further divided by daily cigarette consumption), and former smokers.
Main Results:
- Current smokers had a significantly elevated risk of nonfatal stroke compared to never-smokers.
- The risk increased with the number of cigarettes smoked daily, with those smoking 20+ cigarettes having a 2.52-fold increased risk.
- Former smoking was not significantly associated with an increased risk of stroke.
Conclusions:
- Current cigarette smoking is a significant risk factor for stroke in men.
- Smoking cessation appears to mitigate the increased risk of stroke.
- Smoking contributes substantially to stroke-related morbidity and mortality in the male population.
Objective:
To examine the association between cigarette smoking and the risk for stroke in men.
Design:
Prospective cohort study.
Setting:
Participants in the Physicians' Health Study, a randomized trial of aspirin and beta-carotene among U.S. male physicians.
Patients:
22,071 men, 40 to 84 years of age at entry, free from self-reported myocardial infarction, stroke, and transient ischemic attack; followed for an average of 9.7 years; and classified as never-smokers, current smokers, and former smokers based on self-report.
Measurements:
Incidence rates of total, ischemic, and hemorrhagic stroke.
Results:
With never-smokers as the reference group (relative risk, 1.00), relative risks (adjusted for age and treatment assignment) for total nonfatal stroke (n = 312) were as follows: former smoking, 1.20 (95% CI, 0.94 to 1.53); currently smoking fewer than 20 cigarettes daily, 2.02 (CI, 1.23 to 3.31); and currently smoking 20 or more cigarettes daily, 2.52 (CI, 1.75 to 3.61) (P for trend, < 0.0001). For participants who had total fatal stroke (n = 28), the risk for stroke was not increased with smoking (P > 0.2). In proportional-hazards models that controlled simultaneously for other risk factors, these associations were not materially altered.
Conclusions:
Current but not former cigarette smoking was significantly associated with an increased risk for stroke in men. Smoking may account for a substantial amount of stroke-associated morbidity and mortality.
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