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Neurology. 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.

Collaborators (241)

Bladin C, Davis S, Wijeratne T, Levi C, Parsons M, Brodtmann A, Ng S, Archer J, Delcourt C, Winder TR, Berger L, Boulanger JM, Chan RK, Spence JD, Durocher A, Mackey A, Verreault S, Minuk J, Penn AM, Shuaib A, Cote R, Selchen D, Bayer N, Sweet M, Malik S, Stotts G, Griewing B, Soda H, Weinhardt R, Berrouschot J, Stoll A, Witte OW, Günther A, Bodechtel U, Schminke U, Hobohm C, Hetzel A, Lambeck J, Wartenberg KE, Huttner H, Dittrich R, Nabavi DG, Gröschel K, Thomalla G, Rosenkranz M, Jander S, Meisel A, Ludolph A, Althaus K, Huber R, Lorenz M, Tanne D, Merzlyak O, Bornstein NM, Telman G, Lampl Y, Streifler J, Weller B, Ifergane G, Wirgin Y, Carolei A, Toni D, Stanzione P, Micieli G, Agnelli G, Caso V, Gandolfo C, Comi G, Consoli D, Rasura M, Di Lazzaro V, Dixit A, Jupp B, Shaw L, Salih I, Esisi B, Power M, Strain WD, Elyas S, Manawadu D, Kalra L, O'Brien E, Warburton E, Chatterjee K, Hargroves DR, Blight A, Moynihan B, Markus HS, Macleod MJ, Broughton DL, Rodgers H, Hlaing T, Muir S, Sajid M, Bath PMW, Price C, Sekaran L, Vahidassr D, Muir KW, McIlmoyle J, Datta PK, Davey R, Langhorne P, Stott D, Datta PK, England TJ, Muhidden K, O'Connell JE, Majmudar N, Schindler J, Clark WM, Sethi P, Rordorf G, Kleindorfer DO, Silliman SL, Gorman M, Kelly MA, Singleton L, Meyer BC, Jackson C, Walker J, Ehtisham A, Goodpasture HC, Wang D, Fayad P, Cordina S, Naritoku D, Chiu D, Lukovits T, Goddeau R, Clark-Arbogast R, Leigh R, Wityk RJ, Pettigrew LC, Tayal AH, Jarouse J, Friday GH, Sen S, Kim AS, Johnston SC, Elkins JS, Barrett AM, Leira EC, Kelly A, Burgin S, Rempe DA, Jacoby MRK, Hughes DB, Majersik J, Skalabrin EJ, Lee JM, Hsu C, Sundararajan S, Slivka A, Minagar A, Alicic R, Geraghty M, Kase CS, Lansberg M, Albers G, Dietrich DW, Hanna JP, Gentile NT, Santiago F, Katzan I, Ching M, Sawyer, Warwick T, Yilmaz E, Pedelty L, Schneck MJ, Coull BM, Solenski NJ, Johnston K, Lee V, Prabhakaran S, Johnson MD, Silverman IE, Salgado MW, Birkhahn R, Strawsburg R, Altafullah I, Cohen DA, Zweifler R, Lee Kwen P, Hammer MD, Vora N, Tietjen GE, Albakri E, Dandapani BBK, Jickling G, Verro P, Roller MJ, Hughes RL, Simpson J, Vidic TR, Lash S, Sigsbee B, Rosenbaum D, Fonzetti P, Fleck JD, Goldszmidt AJ, Alexandrov AV, Halsey JH, Hart R, Sattin JA, Kumar S, Book D, Torbey M, Poock JJ, King MK, Graham GD, Sung GY, Mirsen T, Dromerick AW, Runheim AD, Jackson CM, Feen E, Reichwein RK, Waters MF, Amory C, Bernardini GL, Bell RD, Diamond BF, Rosenbaum DM, Palestrant D, Segal AZ, Burger K, Schwartz RL, Mitsias P, Kramer J, Kramer J, Robbins D, Silver B, Easton JD, Feldmann E, Rymer MM, Dorssom J, Ali L, Ovbiagele B, Kirshner HS.

Author information

1
From the Yale School of Medicine (K.A.E., C.M.V., L.H.Y., S.E.I., B.G., W.N.K.), New Haven, CT; University of Western Ontario (J.D.S.), London, Canada; Maine Medical Center (M.G.), Portland; Fred Hutchinson Cancer Research Center (P.D.G.), Seattle, WA; University of Newcastle Upon Tyne (A.D.), Newcastle, UK; and Alpert Medical School of Brown University (K.L.F.), Providence, RI.
2
From the Yale School of Medicine (K.A.E., C.M.V., L.H.Y., S.E.I., B.G., W.N.K.), New Haven, CT; University of Western Ontario (J.D.S.), London, Canada; Maine Medical Center (M.G.), Portland; Fred Hutchinson Cancer Research Center (P.D.G.), Seattle, WA; University of Newcastle Upon Tyne (A.D.), Newcastle, UK; and Alpert Medical School of Brown University (K.L.F.), Providence, RI. walter.kernan@yale.edu.

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.

PMID:
28887378
PMCID:
PMC5644463
DOI:
10.1212/WNL.0000000000004524
[Indexed for MEDLINE]
Free PMC Article

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