Resuming smoking after stroke can increase risk of mortality

Patients who resume smoking after a stroke increase their risk of death by three-fold, according to research presented at ESC Congress 2012 by Professor Furio Colivicchi from San Filippo Neri Hospital. The researchers also found that the earlier patients resume smoking, the greater their risk of death with one year.

"It is well established that smoking increases the risk of having a stroke," said Professor Colivicchi. "Quitting smoking after an acute ischemic stroke may be more effective than any medication in reducing the risk of further adverse events. However, on the other hand, our study shows that stroke patients resuming active smoking after leaving the hospital can raise their risk of dying by as much as three-fold."

The purpose of the study was to gauge the effects of resuming smoking after a stroke, and to see how many patients are likely to relapse. Cardiologists from S. Filippo Neri Hospital in Rome, in collaboration with neurologists from the Santa Lucia Foundation of Rome, tracked 921 patients (584 men and 337 women, mean age 67 ± 16 years) who reported being regular smokers before they were hospitalized with acute ischemic stroke.

All patients ceased smoking while in the hospital and declared themselves motivated to continue abstaining once they were discharged. In addition, all patients attended brief smoking cessation counseling sessions while in the hospital, but no nicotine replacement or other smoking cessation help was provided after they left the hospital.

Patients were interviewed about their smoking status at one, six, and 12 months after their release from the hospital and by the end of the first year 493 (53%) had resumed regular smoking. Older patients and women were more likely to relapse.

Within a year 89 patients died, which equates to a one-year probability of death of 9.6%. After adjusting for patient ages and other clinical variables such as stroke severity, presence of diabetes, hypertension or coronary artery disease, the researchers found that resuming smoking raised a person's risk of death by about three-fold compared to patients who didn't relapse. Moreover, the earlier a patient relapsed, the more likely he or she was to die within a year. "In fact, those who resumed smoking within 10 days of leaving the hospital were five times more likely to die within a year than those who continued to abstain," said Professor Colivicchi.

He added: "The results of this study suggest that healthcare providers should take smoking cessation interventions more seriously, as recommended treatments are not making their way into practice. A successful programme to help stroke patients quit smoking should take a comprehensive long-term approach, including individual counseling, post-discharge support and pharmacological treatment."