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. 2017 Oct 17;89(16):1723-1729.
doi: 10.1212/WNL.0000000000004524. Epub 2017 Sep 8.

Smoking cessation and outcome after ischemic stroke or TIA

Katherine A Epstein  1 , Catherine M Viscoli  1 , J David Spence  1 , Lawrence H Young  1 , Silvio E Inzucchi  1 , Mark Gorman  1 , Brett Gerstenhaber  1 , Peter D Guarino  1 , Anand Dixit  1 , Karen L Furie  1 , Walter N Kernan  2 ; IRIS Trial Investigators
Collaborators, Affiliations

Smoking cessation and outcome after ischemic stroke or TIA

Katherine A Epstein et al. Neurology. .

Abstract

Objective: To assess whether smoking cessation after an ischemic stroke or TIA improves outcomes compared to continued smoking.

Methods: We conducted a prospective observational cohort study of 3,876 nondiabetic men and women enrolled in the Insulin Resistance Intervention After Stroke (IRIS) trial who were randomized to pioglitazone or placebo within 180 days of a qualifying stroke or TIA and followed up for a median of 4.8 years. A tobacco use history was obtained at baseline and updated during annual interviews. The primary outcome, which was not prespecified in the IRIS protocol, was recurrent stroke, myocardial infarction (MI), or death. Cox regression models were used to assess the differences in stroke, MI, and death after 4.8 years, with correction for adjustment variables prespecified in the IRIS trial: age, sex, stroke (vs TIA) as index event, history of stroke, history of hypertension, history of coronary artery disease, and systolic and diastolic blood pressures.

Results: At the time of their index event, 1,072 (28%) patients were current smokers. By the time of randomization, 450 (42%) patients had quit smoking. Among quitters, the 5-year risk of stroke, MI, or death was 15.7% compared to 22.6% for patients who continued to smoke (adjusted hazard ratio 0.66, 95% confidence interval 0.48-0.90).

Conclusion: Cessation of cigarette smoking after an ischemic stroke or TIA was associated with significant health benefits over 4.8 years in the IRIS trial cohort.

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Figures

Figure 1
Figure 1. Time to outcome events
Time to outcome event by smoking status (quitter = blue line, continuing smoker = red line). (A) Stroke, MI, or death; (B) stroke; (C) MI; and (D) death resulting from any cause. MI = myocardial infarction.
See this image and copyright information in PMC

Comment in

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