Stroke survivors more likely than cancer survivors to continue to smoke
Stroke survivors were more likely to continue to smoke than cancer survivors, increasing their risk of having more health problems or dying from stroke or heart disease, according to a new study released today ‘hui in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.
The motivation for this study was the National Cancer Institute (NCI) Moonshot initiative which includes smoking cessation in people with cancer. We were curious to understand smoking in people with stroke and cardiovascular disease. Partly to assess whether a similar program is needed for stroke survivors, our team compared smoking cessation rates between stroke survivors and cancer survivors. “
Neal Parikh, MD, MS, lead study author and neurologist at NewYork-Presbyterian / Weill Cornell Medical Center in New York City
Investigators analyzed data collected between 2013 and 2019 by the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (CDC), a national health survey that collects information on chronic health conditions each year. and health-related behaviors.
Researchers analyzed data from 74,400 respondents who reported having had a previous stroke and history of smoking (median age 68; 45% female; 70% non-Hispanic whites) and 155,693 respondents who were are identified as cancer survivors with a history of smoking (median age 69; 56% female; 81% non-Hispanic white). Previous smoker status was defined as having smoked at least 100 cigarettes in their lifetime.
After adjusting for demographic factors and the presence of smoking-related medical conditions, the researchers found that:
- Stroke survivors were 28% less likely to quit smoking than people with cancer.
- 61% of stroke survivors reported quitting.
- Stroke survivors under the age of 60 were much less likely to have quit (43%) than stroke survivors aged 60 and over (75%).
“If you told a stroke neurologist that 40% of their patients aren’t controlling their blood pressure or taking aspirin or cholesterol-lowering drugs, I think they’d be very disappointed,” said Parikh, who is also an assistant professor of neurology in the department of neurology and neuroscience at the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine. “These results indicate that we should be disappointed – more of our stroke patients are having to quit. We can and should be doing a lot better in helping people quit smoking after stroke.”
The researchers also found that stroke survivors who live in the Stroke Belt – 8 states in the southeastern United States with high stroke rates (North Carolina, South Carolina, Georgia, Tennessee, Alabama , Mississippi, Arkansas and Louisiana) – were about 6% less likely to have quit smoking than stroke survivors in other parts of the United States Increased smoking cessation is a factor that can be treated to reduce the disproportionately high rates of stroke and stroke death in the Stroke Belt.
“The next important steps are to design and test optimal smoking cessation programs for people with stroke or mini-stroke,” said Parikh. “Programs for stroke and cardiovascular disease patients should be as strong as smoking cessation programs for cancer patients. At NCI-designated sites, smoking cessation programs often include a dedicated intensive counseling program, a trained smoking cessation specialist, and health care. professionals with specific knowledge of the use of smoking cessation drugs. Hospital systems could also adjust care protocols so that every stroke patient receives a consultation with a smoking cessation specialist and is enrolled in a smoking cessation program with the option to opt out, as opposed to having to seek out a program.
One of the limitations of the study is that the survey data was self-reported – it relied on individuals to indicate whether they had ever smoked or currently smoked. The study population is also small as it only included people living independently in the community, rather than those living in a nursing home or other living facility.
The co-authors are Melvin Parasram, DO, MS; Halina White, MD; Alexander E. Merkler, MD, MS; Babak B. Navi, MD, MS; and Hooman Kamel, MD, MS
The study was funded by the Empire Clinical Research Program of the New York State Department of Health and the Florence Gould Endowment for Discovery in Stroke.
American Heart Association
Parikh, NS, et al. (2021) Smoking Cessation Among Stroke Survivors in the United States: A National Analysis. Stroke. doi.org/10.1161/STROKEAHA.121.036941.