Cigarette Smoking and Other Risk Factors for Silent Cerebral Infarction in the General Population

Abstract

Background and Purpose-Silent cerebral infarctions (SCIs) have a prevalence between 10% and 40% in the transient ischemic attack population and have been associated with increased mortality and morbidity; however, little is known about the prevalence and risk factors for SCI in the general population. This report focuses on the role of cigarette smoking and other risk factors for SCI in the general population. Methods-MRI scans were performed on 1737 participants selected from the general population as part of the Atherosclerosis Risk in Communities Study. Smoking status and other major cerebrovascular risk factors were assessed, and associations between smoking status and SCIs were established with the use of ANCOVA. Results-Overall, the prevalence of SCI in this population aged 55 to 70 years was 11%. Cigarette smoking had an ordered association (Pϭ0.029) with the presence of SCI, with the odds ratio (OR) of nonsmoking participants exposed to environmental tobacco smoke being 1.06 (95% confidence interval [CI], 0.64 to 1.75) times as great as for nonsmokers not exposed; the OR of past smokers was 1.16 (95% CI, 0.74 to 1.83) times greater, and the OR of current smokers was 1.88 (95% CI, 1.13 to 3.13) times greater. An increased prevalence was also noted among black, older, and hypertensive participants. Conclusions-This report is among the first to examine the risk factors for SCI in the general population and finds a relatively high overall prevalence (11%). There is an ordered relationship between increasing exposure to cigarette smoke and the presence of SCI that parallels the relationship between smoking and carotid atherosclerosis. The magnitude of the association with smoking is substantial compared with the effect of hypertension and other traditional cerebrovascular risk factors. The reduction in prevalence of SCI between current and past smokers and the trend that increased pack-years of smoking is related to increased prevalence of SCI are both additional arguments for smoking avoidance and cessation. (Stroke. 1998;29:913-917.)

Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study

“…We found a prevalence of SBI of 11.3% in community-dwelling subjects with a mean age of 64.5 years. This is comparable with two prior studies, the Atherosclerosis Risk in Community (ARIC) Study 18 and the Framingham Heart Study 11 (prevalence and mean age: 11%, 63 years and 10.7%, 61 years, respectively). A Japanese brain check-up study, among participants who received MRI at their own expense, reported a similar prevalence of 10.6%.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…[9][10][11][12][136][137][138] Stroke risk decreases substantially within 5 years in those who quit smoking compared with continuing smokers. 10,12 In the Framingham Heart Study, the relative risk of carotid artery stenosis >25% was approximately 1.1 for every 10-mg/dL increase in total cholesterol.…”

Listening to the sound of silence between men and women

“…6,7 In Japanese patients, the risk of clinical stroke was significantly higher in subjects with SBI (around a threefold increase) than in those without SBI; 8 therefore, the presence of SBI could tell us of the need for an interventional approach to prevent the onset of severe cerebral ischemia. The risk factors for SBI, such as metabolic syndrome, 9 hypertension 10 and smoking, 6 have been reported previously. Interestingly, among older Japanese subjects, white-coat hypertensives do not show an increase in the prevalence of SBI compared with normotensives.…”

“…5 The incidence of SBI in the general population is relatively high; overall, its prevalence is around 11%. 6 The presence of SBI may allow us to clinically predict overt stroke in the future. 6,7 In Japanese patients, the risk of clinical stroke was significantly higher in subjects with SBI (around a threefold increase) than in those without SBI; 8 therefore, the presence of SBI could tell us of the need for an interventional approach to prevent the onset of severe cerebral ischemia.…”

“…6 The presence of SBI may allow us to clinically predict overt stroke in the future. 6,7 In Japanese patients, the risk of clinical stroke was significantly higher in subjects with SBI (around a threefold increase) than in those without SBI; 8 therefore, the presence of SBI could tell us of the need for an interventional approach to prevent the onset of severe cerebral ischemia. The risk factors for SBI, such as metabolic syndrome, 9 hypertension 10 and smoking, 6 have been reported previously.…”