Paradoxical Effect of Smoking in the Spanish Population With Acute Myocardial Infarction or Unstable Angina

Ruiz-Bailén, Manuel; Hoyos, Eduardo Aguayo de; Reina-Toral, Antonio; Torres-Ruiz, Juan Miguel; Alvarez-Bueno, Miguel; Jiménez, Francisco

doi:10.1378/chest.125.3.831

Cited by 56 publications

(41 citation statements)

References 34 publications

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“…The 'smoker's paradox' observed in our study has been well described in previous studies of myocardial infarctions [28][29][30] , but was not observed in a large stroke outcome study conducted in China [31] . The Copenhagen Stroke Study found a protective effect of smoking on 5-year survival in univariate analyses, but a 20% excess after multivariate adjustment [32] .…”

Section: Discussionsupporting

confidence: 87%

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Pathak¹,

Sloan

2009

Neuroepidemiology

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Background: Black-white disparities in stroke mortality are well documented, but few recent studies have examined racial/ethnic disparities in stroke hospitalizations among young adults. We analyzed recent (2001–2006) trends in stroke hospitalizations and hospital case-fatality for black, Hispanic, and white adults aged 25–49 years in Florida. Methods: Hospitalization rates were calculated using population estimates from the census, and hospital discharges with a primary diagnosis of stroke (ICD-9-CM 430, 431, 434, 436) (n = 16,317). Multivariate logistic regression modeling was used to examine racial/ethnic disparities in stroke mortality prior to discharge, after adjustment for patient sociodemographics, stroke subtype, risk factors, and comorbidities. Results: Age-adjusted stroke hospitalization rates for blacks were over 3 times higher than rates for whites, while rates for Hispanics were slightly higher than rates for whites. Hemorrhagic strokes were proportionally greater among Hispanics compared with blacks and whites (p < 0.0001). Blacks were most likely to have diagnosed hypertension (62.3%), morbid obesity (10.9%) or drug abuse (13.6%). Whites were most likely to have diagnosed hyperlipidemia (21.0%), alcohol abuse (9.5%), and to be smokers (30.6%). The in-hospital fatality rate for all strokes was highest among blacks (10.0%) compared with whites (9.0%) and Hispanics (8.2%). After adjustment for age, gender, insurance status, and all diagnosed risk factors and comorbidities, the black excess was no longer observed [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.88–1.15, p = 0.93]. However, the Hispanic advantage in case-fatality was strengthened (OR 0.66, 95% CI 0.55–0.79, p < 0.0001). Separate case-fatality analyses for ischemic versus hemorrhagic strokes yielded similar results. Conclusions: Our study found a strong and persistent black-white disparity in stroke hospitalization rates for young adults. In contrast, rates were similar for Hispanics and whites. Multivariate adjustment explained the 15% excess case-fatality for blacks; the short-term mortality advantage among Hispanics was strengthened after adjustment.

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Section: Discussionsupporting

confidence: 87%

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Pathak¹,

Sloan

2009

Neuroepidemiology

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“…Indeed, consistently with some findings for acute myocardial infarction [2,3], several studies have suggested that smokers experiencing an ischemic stroke (IS) may have improved recovery [4], and a better response to thrombolysis than non-smokers [5]. These results could be explained by a less severe baseline stroke severity in smoking patients [6,7,8], but other studies failed to demonstrate such an association [4,5,9,10,11].…”

Section: Introductionsupporting

confidence: 90%

“…The patients were classified as former smokers, non-smokers, and current smokers. Former smokers included patients who had not smoked for at least 3 months, non-smokers included patients who have never smoked, and current smokers included the remainder of the patients [17]. Smoking was defined to include all possible forms of smoking, including pipes or cigarettes.…”

Section: Methodsmentioning

confidence: 99%

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

et al. 2013

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We aimed to investigate the impact of smoking status on clinical severity in patients with ischemic stroke event (IS). Patients were prospectively identified among residents of the city of Dijon, France (ca. 151,000 inhabitants), using a population-based registry, between 2006 and 2011. Demographic and clinical data were recorded. The initial clinical severity was quantified by the means of the National Institutes of Health Stroke Scale (NIHSS). Multivariable ordinal logistic regression was used to assess the effect of smoking status on severity. Among the 1,056 recorded patients with IS, data about smoking status were available for 973 (92.1%), of whom 658 (67.3%) were non-smokers, 187 (19.2%) were current smokers, and 128 (13.2%) were former smokers. Compared with non-smoking, former smoking was associated with less severe IS (OR 0.55; 95% CI 0.38-0.82, p = 0.003), whereas this association was not found for current smokers (OR 0.97; 95% CI 0.69-1.36, p = 0.856). Further work is needed to understand the underlying mechanisms of this finding.

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“…Anesthesiologists may be reluctant to advocate smoking cessation shortly before surgery because the benefits of a short period of abstinence (less than four weeks) are uncertain, and there could possibly be increased risks of postoperative respiratory 12 or cardiovascular complications, or mortality. 13 Interestingly, a paradoxical effect of lower mortality and improved outcome was observed in smokers compared with nonsmokers after acute myocardial infarction, heart failure, and stroke. [14][15][16] These data suggest that it may be inappropriate to stop smoking shortly before surgery.…”

Section: Constatations Principalesmentioning

confidence: 99%

Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis

Wong

Lam

Abrishami

et al. 2011

Can J Anesth/J Can Anesth

329

161

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Purpose The literature was reviewed to determine the risks or benefits of short-term (less than four weeks) smoking cessation on postoperative complications and to derive the minimum duration of preoperative abstinence from smoking required to reduce such complications in adult surgical patients. Source We searched MEDLINE, EMBASE, Cochrane, and other relevant databases for cohort studies and randomized controlled trials that reported postoperative complications (i.e., respiratory, cardiovascular, woundhealing) and mortality in patients who quit smoking within six months of surgery. Using a random effects model, meta-analyses were conducted to compare the relative risks of complications in ex-smokers with varying intervals of smoking cessation vs the risks in current smokers. Principal findings We included 25 studies. Compared with current smokers, the risk of respiratory complications was similar in smokers who quit less than two or two to four weeks before surgery (risk ratio [RR] 1.20; 95% confidence interval [CI] 0.96 to 1.50 vs RR 1.14; CI 0.90 to 1.45, respectively). Smokers who quit more than four and more than eight weeks before surgery had lower risks of respiratory complications than current smokers (RR 0.77; 95% CI 0.61 to 0.96 and RR 0.53; 95% CI 0.37 to 0.76, respectively). For wound-healing complications, the risk was less in smokers who quit more than three to four weeks before surgery than in current smokers (RR 0.69; 95% CI 0.56 to 0.84). Few studies reported cardiovascular complications and there were few deaths. Conclusion At least four weeks of abstinence from smoking reduces respiratory complications, and abstinence of at least three to four weeks reduces wound-healing complications. Short-term (less than four weeks) smoking cessation does not appear to increase or reduce the risk of postoperative respiratory complications.Author contributions Jean Wong was involved in data abstraction, interpretation of data, drafting and revising, and final approval of the article. David Paul Lam was involved in data abstraction and drafting of the article. Amir Abrishami was involved in drafting and revising the article, data analysis, and interpretation of the data. Matthew Chan revised and approved the final version of the article. Frances Chung was involved in the conception and design, revising, and final approval of the article. (RR: 0,77; IC a`95 %: 0,96 et RR: 0,53; IC a9 5 %: 0,76, respectivement). Concernant les complications lie´es a`la cicatrisation, le risque a e´te´plus faible chez les fumeurs ayant cesse´plus de trois a`quatre semaines avant l'intervention que chez les fumeurs actifs (RR: 0,69; IC a`95%: 0,56-0,84). Peu d'e´tudes ont de´crit des complications cardiovasculaires et il n'y a eu que peu de de´ce`s. Conclusion Un minimum de quatre semaines d'abstinence du tabagisme diminue le risque de complications respiratoires et un minimum de trois a`quatre semaines re´duit le risque de complications lie´es a`la cicatrisation. L'arreˆt à court terme (moins de quatre semaines) du tab...

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Paradoxical Effect of Smoking in the Spanish Population With Acute Myocardial Infarction or Unstable Angina

Cited by 56 publications

References 34 publications

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis

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