Home Medizin Aktives Rauchen oder die Exposition gegenüber Tabakrauch in der Umgebung sind mit einem erhöhten Risiko für alle Schlaganfälle und die wichtigsten pathologischen und ätiologischen Subtypen verbunden

Aktives Rauchen oder die Exposition gegenüber Tabakrauch in der Umgebung sind mit einem erhöhten Risiko für alle Schlaganfälle und die wichtigsten pathologischen und ätiologischen Subtypen verbunden

von NFI Redaktion

A recent study published in EClinicalMedicine investigated how tobacco consumption and exposure influence the risk of stroke, depending on type, region, and income level.


Study: Tobacco consumption and risk of acute stroke in 32 countries in the INTERSTROKE study: A case-control study. Image credit: chayanuphol/Shutterstock.com









Study: Tobacco consumption and risk of acute stroke in 32 countries in the INTERSTROKE study: A case-control study. Image credit: chayanuphol/Shutterstock.com

Background

Tobacco consumption significantly contributes to global mortality, disability, and cardiovascular diseases, with 29.6% of men and 5.3% of women worldwide smoking daily. In 2016, strokes accounted for 5.5 million deaths and 116.4 million disability-adjusted life years (DALYs), representing 11.5% of global deaths. While smoking rates are decreasing globally, some regions are experiencing an increase in both sexes.

Smoking is a major risk factor for strokes, especially ischemic strokes. The INTERSTROKE study shows that the global stroke risk attributable to smoking is 12.4%. Passive smoking also increases the risk of strokes, but smoking cessation can quickly reduce this risk. Further research is essential to develop targeted interventions and guidelines addressing the effects of tobacco consumption and exposure on stroke risk in different populations and regions.

About the Study

The international INTERSTROKE study identified stroke risk factors by including participants from 142 centers in 32 countries between January 11, 2007, and August 8, 2015. The study covered various regions, including Western Europe, North America, Eastern Europe, the Middle East, Africa, South Asia, China, Southeast Asia, and South America, classifying countries based on income levels into high, upper middle, and lower middle/low income. It focused on individuals who had their first acute stroke confirmed by neuroimaging compared to community or hospital controls, with all participants giving informed consent.

Data collection involved a structured questionnaire and physical examinations to determine tobacco consumption habits, including cigarettes, non-cigarette tobacco, and exposure to environmental tobacco smoke (ETS), as well as physiological measurements and medical history. Tobacco consumption was categorized as „current,“ „former,“ or „never,“ with additional details on the type and frequency of consumption. The study accurately assessed ETS exposure based on interactions with smokers in the participants‘ environment.

Statistical analysis used univariate associations for initial data exploration, with more complex multivariable logistic regression models considering potential confounders like age, gender, and lifestyle factors to evaluate the effects of tobacco on stroke risk. Population-attributable risk (PAR) was calculated to estimate the impact of tobacco consumption on stroke incidence adjusted for confounders and stratified by different subgroups. Advanced statistical software was used for analyses to ensure a comprehensive understanding of the relationship between tobacco exposure and stroke risk.

Study Results

In this study, researchers presented basic characteristics of both controls and cases, focusing on different stroke subtypes and the effects of various tobacco products, including factors like age, body mass index (BMI), and cholesterol levels. The data revealed gaps in several areas, such as psychosocial factors and diabetes history, although the majority of participants had data recorded on lipids and hemoglobin A1c (HbA1c) levels.

The prevalence of smoking, broken down by region, gender, and quantity of tobacco products consumed daily, showed significant regional differences. For example, Eastern Europe and North America exhibited higher smoking prevalence among young women, while the highest rates among young men were observed in China.

The results suggest that current smoking is associated with increased risk across all stroke types, with the risk being particularly pronounced for ischemic strokes and less pronounced for intracerebral hemorrhages (ICH). Among the etiological subtypes of ischemic stroke, current smokers showed different odds ratios (ORs), with large vessel stroke posing the highest risk.

Filtered cigarettes, unfiltered cigarettes, and beedies (alone or in combination) all were associated with an increased stroke risk. Notably, the risk of ischemic stroke increased with the number of cigarettes smoked per day, demonstrating a dose-response relationship, but former smoking did not have a significant impact on stroke risk.

The study also found that the risk and PAR of stroke related to current smoking varied significantly by region, with Western Europe/North America showing the highest risk and PAR, especially among young smokers. Income level also influenced the odds ratio and PAR, increasing from high-income countries to low middle/low-income countries. A notable dose-response relationship between the number of cigarettes smoked per day and stroke risk was apparent across all income levels, particularly in high-income countries.

A significant portion of controls reported ETS exposure, with longer exposure hours correlating with a higher risk of ischemic stroke, ICH, and various Trial of Org 10172 (TOAST) subtypes. Prolonged weekly ETS exposure increased the risk for all stroke types and underscores the harmful effects of both active smoking and passive smoke exposure on stroke risk.

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