Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Mar;98(12):e14872.
doi: 10.1097/MD.0000000000014872.

The relationship between smoking and stroke: A meta-analysis

Biqi Pan  1 , Xiao Jin  2 , Liu Jun  3 , Shaohong Qiu  1 , Qiuping Zheng  1 , Mingwo Pan  1
Affiliations
Meta-Analysis

The relationship between smoking and stroke: A meta-analysis

Biqi Pan et al. Medicine (Baltimore). 2019 Mar.

Abstract

Background: Stroke is one of the leading causes of death and disability for adult men and women worldwide, and a number of studies have explored the influences of smoking on stroke. However, few studies have discussed the relationship between stroke and smoking with consideration of the following factors: sex, the number of cigarettes smoked per day, stroke subtype, and the follow-up duration. Consequently, we aimed to extend previous work by using a systematic review to explore the relationship between stroke and cigarette smoking in reference to the above factors.

Methods: A systematic review was conducted using the PubMed, Embase, and Cochrane Central Register databases and the following search criteria: ["stroke" (MeSH) and "smoking" (MeSH)]. All analyses were conducted with Stata, and funnel plots and Egger regression asymmetry tests were used to assess publication bias.

Results: The meta-analysis included 14 studies involving 303134 subjects. According to the meta-analysis, smokers had an overall increased risk of stroke compared with nonsmokers, with a pooled odds ratio (OR) of 1.61 (95% confidence interval [CI]: 1.34-1.93, P < .001). A subgroup analysis conducted based on smoking status revealed ORs of 1.92 (95% CI: 1.49-2.48) for current smokers and 1.30 (95% CI: 0.93-1.81) for former smokers. In addition, the relationship between stroke of any type and smoking status was also statistically significant; current smokers had an increased risk of stoke compared with nonsmokers (OR: 1.46, 95% CI: 1.04-2.07, P < .001), which was influenced by sex (men: OR: 1.54, 95% CI: 1.11-2.13, P = .002; women: OR: 1.88, 95% CI: 1.45-2.44, P < .023). From the analysis, we also observed that passive smoking increased the overall risk of stroke by 45% (OR: 1.45, 95% CI: 1.0-2.11, P < .05). Based on the dose-response meta-analysis, the risk of stroke increased by 12% for each increment of 5 cigarettes per day.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart for the process of selecting eligible publications.
Figure 2
Figure 2
Adjusted relative risk of overall stroke for current smokers compared with former smokers.
Figure 3
Figure 3
Adjusted relative risk of overall stroke for former smokers compared with nonsmokers.
Figure 4
Figure 4
Linear dose-dependent relationship between number of cigarettes smoked per day and the relative risk of stroke among all subjects.
Figure 5
Figure 5
Filled funnel plot for smoking and the overall risk of stroke.
See this image and copyright information in PMC

References

    1. Li WA, Geng X, Ding Y. Stroke is a global epidemic: new developments in clinical and translational cerebrovascular diseases research. Neurol Res 2017;39:475–6. - PubMed
    1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2013 update: a report from the American heart association. Circulation 2013;127:e6–245. - PMC - PubMed
    1. Lackland DT, Roccella EJ, Deutsch AF, et al. Factors influencing the decline in stroke mortality: a statement from the American heart association/American stroke association. Stroke 2013;45:315–53. - PMC - PubMed
    1. Arnao V, Acciarresi M, Cittadini E, et al. Stroke incidence, prevalence and mortality in women worldwide. Int J Stroke 2016;11:287–301. - PubMed
    1. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014;311:183–92. - PubMed

Publication types

Substances