Disclosures: The authors report no relevant financial disclosures.
June 10, 2020
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Smoking cigarettes increases stroke risk in black adults

Disclosures: The authors report no relevant financial disclosures.
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Black adults who currently smoked cigarettes had a dose-dependent higher risk for stroke compared with those who never smoked or did so in the past, according to a study published in the Journal of the American Heart Association.

“African Americans have been targeted by tobacco companies,” Michael E. Hall, MD, MS, associate professor of medicine, radiology, and physiology and biophysics, associate division director of cardiovascular diseases and director of clinical and population sciences at the Mississippi Center for Clinical and Translational Research at University of Mississippi Medical Center in Jackson, told Healio. “Given their increased risk of CVD and being targeted by these marketing strategies, this makes them a vulnerable population. We now have further evidence that shows a strong link between cigarette smoking and stroke in African Americans.”

As the number of daily cigarettes increases, so too does the risk for stroke.

Jackson Heart Study data

Adebamike A. Oshunbade, MD, MPH, postdoctoral research fellow at the University of Mississippi Medical Center and fellow of the American Heart Association Tobacco Regulation and Addiction Center, and colleagues analyzed data from 4,410 participants (mean age, 54 years; 36% men) from the Jackson Heart Study who did not have a history of stroke or CVD at baseline.

Michael E. Hall
Adebamike A. Oshunbade

“We know from population studies such as the Framingham Heart Study that smoking is a major risk factor for cardiovascular diseases including stroke,” Hall said in an interview. “However, less is known about these risk factors in African Americans who are disproportionately affected.”

Participants self-reported their cigarette smoking status through a questionnaire at baseline. This information was used to categorize participants as never-smokers (n = 3,083; mean age, 53 years; 30% men), past smokers (n = 781; mean age, 59 years; 47% men) and current smokers (n = 546; mean age, 52 years; 51% men). Researchers also categorized participants by smoking intensity as either smoking between one and 19 cigarettes per day or at least 20 cigarettes per day.

Participants were followed up through 2015 for incident stroke, which was defined on the bases of the history of stroke, transient ischemic attack, or angioplasty, carotid endarterectomy or both.

During a median follow-up of 11.8 years, 183 participants had a stroke, for an incidence rate of 3.49 per 1,000 person-years. Compared with never-smokers, those who were current and past smokers had a higher incidence of stroke (P for log-rank = .0001).

Stroke risk in current smokers was significantly higher compared with never-smokers (HR = 2.48; 95% CI, 1.6-3.83) after adjusting for CV risk factors. A significant difference was not observed when comparing past smokers with never-smokers (HR = 1.1; 95% CI, 0.74-1.64).

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The relationship between smoking and stroke risk was slightly weaker in current smokers who smoked between one and 19 cigarettes per day (HR vs. never-smokers = 2.28; 95% CI, 1.38-3.86) than in those who smoked 20 or more cigarettes per day (HR vs. never-smokers = 2.78; 95% CI, 1.47-5.28).

Research in other tobacco products

“Further research is needed to assess the risks and potential harm of other tobacco products including e-cigarettes, cigars, among others,” Hall told Healio. “Many of these products contain similar components, which may be harmful to the cardiovascular system; however, we lack good long-term data on their effects. Therefore, some have touted products such as e-cigarettes as a way to reduce CV harm in people who are current traditional cigarette smokers. However, given what we know about many of the components of traditional cigarettes and the fact that many of these are also present in or byproducts of e-cigarettes or vaping, further investigation is needed to assess these potential effects.”

For more information:

Michael E. Hall, MD, MS, can be reached at mehall@umc.edu.