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Association between post-stroke smoking and stroke recurrence in first-ever ischemic stroke survivors: based on a 10-year prospective cohort

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Abstract

Background

Whether smoking is a risk factor for ischemic stroke (IS) recurrence in IS survivors is still uncovered, and evidences are sparse. Meanwhile, an add-on effect of clopidogrel was observed in myocardial infarction patients who smoked, but whether the paradox exists in IS patients is still unsolved. The objectives of this study are to explore the association between smoking behavior after index stroke and IS recurrence and to explore whether the paradox exists.

Methods

A prospective cohort of first-ever IS patients was conducted between 2010 and 2019. The prognosis and smoking features of enrolled patients were obtained via telephone follow-up every 3 months. Fine-gray model with interaction terms was applied to measure the relationships between stroke recurrence and smoking behaviors after index stroke and to explore the add-on effect of clopidogrel in smoking patients.

Results

There were 171 (24.26%) recurrences and 129 (18.30%) deaths during follow-up in 705 enrolled IS patients. One hundred forty-six (20.71%) patients smoked after index stroke. The hazard ratios (HRs) and 95% confidence intervals (CIs) of interaction terms between antiplatelet drug and follow-up smoking (smoking status and daily smoking amount) were 1.092 (95% CI: 0.524, 2.276) and 0.985 (95% CI: 0.941, 1.031), respectively. A significantly higher risk of recurrence was observed in patients with a higher daily smoking amount during follow-up (per cigarette), with HR being 1.027 (95% CI: 1.003, 1.052).

Conclusions

Smoking could elevate the risk of IS recurrence, and IS survivor should be advised to quit or smoke less. Add-on effect of clopidogrel may not exist in smoking strokers taking clopidogrel.

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Abbreviations

BMI:

Body mass index

CE:

Cardio-embolism

CI:

Confidence interval

CIF:

Cumulative incidence function

CYP:

Cytochrome P450

HR:

Hazard ratio

IS:

Ischemic stroke

LAR:

Large artery atherosclerosis

MI:

Myocardial infarction

mRS:

Modified Rankin score

ODC:

Stroke of other determined causes

PRU:

P2Y12 reaction unit

SAO:

Small artery occlusion

SI:

Smoking index

SMD:

Standard mean difference

TOAST:

Trial of Org 10172 in Acute Stroke Treatment

VIF:

Variance inflammation coefficient

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Funding

This research was supported by grants from National Natural Science Foundation of China (grant no. 82173618, no. 81673273, and no. 30600511, http://www.nsfc.gov.cn/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funding agreement ensured the authors’ independence in designing the study.

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Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China

    Qiang Yao, Bai-Yang Zhang, Yi-Die Lin, Mei-Jing Hu, Min Jiang & Cai-Rong Zhu

  2. Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Mu-Ke Zhou

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  1. Qiang Yao
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Correspondence to Mu-Ke Zhou or Cai-Rong Zhu.

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Ethical approval and consent to participate

The study protocol was approved by the Ethics Committee of the West China Hospital, Sichuan University, Chengdu, China (ethical approval number: “2009 year 50”). All patients had signed informed consent before the baseline survey. We confirmed that all methods were performed in accordance with relevant guidelines and regulations.

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Yao, Q., Zhang, BY., Lin, YD. et al. Association between post-stroke smoking and stroke recurrence in first-ever ischemic stroke survivors: based on a 10-year prospective cohort. Neurol Sci 44, 3595–3605 (2023). https://doi.org/10.1007/s10072-023-06873-y

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