Cigarette Smoking as a Determinant of High-Grade Carotid Artery Stenosis in Hispanic, Black, and White Patients With Stroke or Transient Ischemic Attack

Abstract

Background and Purpose-We sought to investigate the association of cigarette smoking with high-grade carotid artery stenosis in Hispanic, black, and white patients with cerebral ischemia in two independent samples. Methods-Prospectively collected data from the Northern Manhattan Stroke Study (NOMASS) (nϭ431) and the Berlin Cerebral Ischemia Databank (BCID) (nϭ483) were used separately for a cross-sectional study estimating the association between cigarette smoking and high-grade carotid stenosis (defined as a luminal narrowing of Ն60%, diagnosed by duplex and/or Doppler ultrasound). In both studies, cerebral ischemia patients with normal sonographic findings or nonstenosing plaques of their carotid arteries served as a comparison group. Multivariate logistic regression models were used for statistical tests to determine the association between smoking and the dependent variable for high-grade carotid stenosis. Age, sex, hypertension, diabetes, hypercholesterolemia, and race/ethnicity were considered potential confounders. Further analyses of the NOMASS data estimated the effect of the amount of cigarette use and the impact of race/ethnicity. Results-High-grade carotid stenoses were found in 14% of the NOMASS and in 21% of the Berlin patients. In Berlin the entire sample was white, whereas in New York only 19% of the cohort were white. In both samples, smoking was independently associated with severe carotid stenosis (NOMASS: odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1 to 2.0; BCID: OR, 3.9; 95% CI, 2.4 to 6.4). Patients smoking 20 pack-years or more showed a significant association (OR, 2.0; 95% CI, 1.1 to 3.9), whereas no significant effect was found for lower amounts of cigarette use. In NOMASS, white smokers displayed a significant (OR, 3.2; 95% CI, 1.1 to 8.9) association with high-grade carotid stenosis, the association for black smokers was less strong, and no association was found among Hispanics. Conclusions-Smoking is an independent determinant of severe carotid artery stenosis in patients with focal cerebral ischemia. The association differs by race/ethnicity, with the greatest effect observed among whites. (Stroke. 1998;29:908-912.)

Risk Factors, Outcome, and Treatment in Subtypes of Ischemic Stroke: The German Stroke Data Bank

“…18,23 Our finding that smoking is mainly associated with stroke due to large-artery atherosclerosis is in accordance with our own hypothesis and with previous results. 2,24,25 Smoking may furthermore contribute to uncommon etiologies in younger patients (eg, coagulopathy in female smokers taking oral contraceptives) but appears to be less important in other stroke subtypes. Smoking was not unanimously identified as a risk factor for stroke by large prospective studies.…”

Smoking Attenuates the Beneficial Effect of Physical Activity on Intima-Media Thickness of Carotid Artery in Young and Middle-Aged Smokers

“…Bhat et al [16] analyzed the data from the Stroke Prevention in Young Women Study, a population-based case-control study of risk factors for ischemic stroke in women aged 15 -49 years old, and reported a strong dose-response relationship between cigarette smoking and ischemic stroke risk in young women. Mast et al [17] collected data from two prospective studies and showed that smoking was significantly associated with highgrade carotid artery stenosis (> 60%), especially in white smokers who smoked 20 pack-years or more, and that this effect was independent of other risk factors. Regarding IMT, Nakashima et al [18] reported a positive correlation between maximum IMT and smoking in hemodialysis patients, but no correlation between mean IMT and smoking.…”

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

“…30 Subarachnoid hemorrhage was most clearly associated with smoking, and cerebral infarction was almost twice as likely in smokers compared with non-smokers. Although smoking may be more strongly related to atherogenic strokes rather than small vessel disease, 31 the smoking-associated increased risk was found for lacunar infarction. 32,33 Mannami et al 33 summarized several plausible mechanisms for smoking-related risk of stroke such as hypercoagulable states, reduced blood flow, reduced HDL cholesterol and direct injury to endothelial cells.…”