International Stroke Conference
International Stroke Conference
February 13, 2020
2 min read

Smoking after stroke remains at 1999 levels despite decline in general population

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Neal S. Parikh

Between 1999 and 2016, the general prevalence of smoking steadily declined, but in the stroke survivor population, smoking, which may hinder secondary prevention, remained stagnant, according to research presented at the International Stroke Conference.

Among the overall cohort of 49,440 participants from the National Health and Nutrition Examination Survey, smoking decreased from 25% to 19% between 1999 and 2016 (OR per cycle = 0.96; 95% CI, 0.94-0.97) while smoking in stroke survivors, who comprised 2.7% of the cohort, remained relatively unchanged, shifting from approximately 23% to 26% (OR per cycle = 1.01; 95% CI, 0.93-1.09).

“Our data show that whereas the rate of active smoking has decreased in the general U.S. population, the rate of active smoking has not decreased among adults with a prior stroke during the same time period,” Neal S. Parikh, MD, assistant professor of neurology at Weill Cornell Medicine, told Healio. “This suggests that efforts to achieve smoking cessation as part of secondary prevention, prevention of recurrent stroke and cardiovascular disease after a first stroke, are not currently adequately successful. Clinicians should emphasize the importance of, and resources for, smoking cessation alongside counseling regarding adherence to antithrombotic therapies and BP control, among other risk factor control topics.”

In other findings, the average prevalence of smoking between 1999 and 2016 was 22.2% for the entire cohort and 24.3% among stroke survivors.

“To me, the data speak to the addictive nature of nicotine, and the habit-forming nature of tobacco smoking,” Parikh said in an interview. “Conventional approaches to smoking cessation are likely not adequate if our goal is to get every stroke survivor to be tobacco-free. Greater use of smoking-cessation therapies and intensive behavioral interventions are likely needed.”

Using trend cycles from NHANES, researchers performed a trend analysis with the aim of assessing whether the rate of smoking among patients with prior stroke has decreased. Prior stroke and active smoking were self-reported by participants and stroke was validated by expert chart review, according to the study. Among stroke survivors, the mean age was 65 years and 57% were women.

“Stroke survivors need to understand that it is not too late at the time of a stroke — the notion that the ‘damage is already done’ is a misconception,” Parikh told Healio. “Patients who continue to smoke after a stroke have been found to be at an increased risk of recurrent stroke and cardiovascular disease. Surviving a stroke is a wake-up call to stop smoking. Quitting ‘cold turkey’ is not the only option — patients should ask their physicians for additional therapies if needed.” – by Scott Buzby


Parikh NS, et al. Poster Presentation WMP111. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.

Disclosure: Parikh reports no relevant financial disclosures.