“Smoking paradox” is not true in patients with ischemic stroke: a systematic review and meta-analysis

Li, Bo; Li, Dan; Liu, Jingfeng; Wang, Lin; Li, Baozhu; Yan, Xiu-Juan; Liu, Wei; Wu, Kun; Xiang, Ruo‐Lan

doi:10.1007/s00415-019-09596-3

Cited by 14 publications

(14 citation statements)

References 31 publications

(39 reference statements)

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“…Smoking had a protective effect. The “smoking paradox” on ischemic stroke outcome, however, was not confirmed in a recent meta-analysis [13]. As expected, increasing stroke severity in terms of NIHSS on admission was associated with worse outcome at 90 days.…”

Section: Discussionmentioning

confidence: 93%

Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

et al. 2020

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Introduction: White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking. Material and Methods: We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation. Results: A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637). Conclusion: The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation.

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Section: Discussionmentioning

confidence: 93%

Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

et al. 2020

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“…29 The results of this study indicate that had smoking history is a protective factor of disability among the elderly with stroke may be due to the effects of passive smoking which were not examined in this study. 30 After controlling for other variables, there was a significant relationship between joint disease status with disability among elderly with stroke The adjusted prevalence ratio (aPR) result was 0.546 (CI 95%= 0.311-0.958), shows that had joint disease was the protective factor of disability among elderly with stroke. This research was not in line with research in England 31 which states that musculoskeletal symptoms are common in people with stroke and have a significant additional effect on the disability of stroke sufferers.…”

Section: Discussionmentioning

confidence: 95%

Risk Factors Associated with Disability among Elderly with Stroke in Indonesia: A Secondary Data Analysis of 2018 National Basic Health Research

Yanti

Santik

2022

Journal of Public Health for Tropical and Coastal Region

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Introduction: According to the 2018 Basic Health Research (Riskesdas), the highest prevalence of stroke occurs among the elderly group. On the other hand, the proportion of disability among the elderly with stroke was highest compared to the elderly with another disease. Disabled elderly resulted in a high burden of care. This study aimed to analyze the risk factors associated with disability among the elderly with stroke in Indonesia.Methods: This cross-sectional study uses secondary data from Riskesdas 2018. The sample was all elderly aged ≥60 years in Indonesia that participated in the Riskesdas 2018 who diagnosed with stroke by a doctor and met the inclusion criteria (2439 samples). This study employed chi-square and logistic regression.Results: The risk factors associated with disability among the elderly with stroke were older age, having a low education level, living in a rural area, not being obese, having a mental emotional disorder, having no smoking history, and less physical activity. Multivariate analysis showed that less physical activity (PR=18.097; 95%CI=7.306-44.825), low level of education (PR=3.555; 95%CI=1.616-7.823), mental emotional disorders (PR=1.942; 95%CI=1.262-2.988) were the risk factors of disability among elderly with stroke. Being obese (PR= 0.578; 95%CI=0.345-0.970), having a joint disease (PR=0.546; 95%CI=0.311-0.958), and having a smoking history (PR=0.461; 95%CI=0.280-0.759) were the protective factors of disability among elderly with stroke.Conclusion: Physical rehabilitation and mental-emotional disorder treatment have important roles in preventing disability among the elderly with stroke

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“…Smoking increases the risk of stroke in the short term by promoting thrombosis [42] and reducing cerebral blood flow via arterial vasoconstriction [43]. However, the thrombotic process can be reversible [44], and cerebral blood flow can significantly improve soon after quitting [25,39,45,46]. It is also possible that our AIS-HF population 65-74 with a previous smoking history showed a lower stroke severity returned to nonsmoking status, and might have quit smoking for a significant period following the onset of AIS.…”

Section: Discussionmentioning

confidence: 99%

“…Although smoking is an apparent risk factor for AIS, some studies [31,37,38]have found an association between smokers that receive thrombolytics and improved clinical outcomes. The most common critique of studies that affirm the paradox is their small sample size [39], and most metanalyses find no association between smoking status and stroke severity [40,41]. The risk of stroke is reported to decrease after 2 to 4 years of smoking cessation and returns to the level of non-smoking status after five years of smoking cessation [25] .…”

Section: Discussionmentioning

confidence: 99%

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Edrissi

Rathfoot

Knisely

et al. 2022

JCM

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Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65–74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65–74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65–74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018–0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987–0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196–1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137–0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009–1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171–9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242–37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008–1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005–1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65–74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65–74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.

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“Smoking paradox” is not true in patients with ischemic stroke: a systematic review and meta-analysis

Cited by 14 publications

References 31 publications

Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

Risk Factors Associated with Disability among Elderly with Stroke in Indonesia: A Secondary Data Analysis of 2018 National Basic Health Research

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

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