Cigarette smoking as a risk factor for stroke. The Framingham Study.

The impact of cigarette smoking on stroke incidence was assessed in the Framingham Heart Study cohort of 4255 men and women who were aged 36 to 68 years and free of stroke and transient ischemic attacks. During 26 years of follow-up, 459 strokes occurred. Regardless of smoking status and in each sex, hypertensive subjects had twice the incidence of stroke. Using the Cox proportional hazard regression method, smoking was significantly related to stroke after age and hypertension were taken into account. Even after pertinent cardiovascular disease risk factors were added to the Cox model, cigarette smoking continued to make a significant independent contribution to the risk of stroke generally and brain infarction specifically. The risk of stroke increased as the number of cigarettes smoked increased. The relative risk of stroke in heavy smokers (greater than 40 cigarettes per day) was twice that of light smokers (fewer than ten cigarettes per day). Lapsed smokers developed stroke at the same level as nonsmokers soon after stopping. Stroke risk decreased significantly by two years and was at the level of nonsmokers by five years after cessation of cigarette smoking.

[1]  R. Paffenbarger,et al.  Characteristics in youth predisposing to fatal stroke in later years. , 1967, Lancet.

[2]  J. Salonen,et al.  Relation of blood pressure, serum lipids, and smoking to the risk of cerebral stroke. A longitudinal study in Eastern Finland. , 1982, Stroke.

[3]  L. Wilhelmsen,et al.  Fibrinogen as a risk factor for stroke and myocardial infarction. , 1984, The New England journal of medicine.

[4]  R Doll,et al.  Mortality of British doctors in relation to smoking: observations on coronary thrombosis. , 1966, National Cancer Institute monograph.

[5]  B. Schulte,et al.  An evaluation of risk factors for stroke in a Dutch community. , 1982, Stroke.

[6]  R. Beaglehole,et al.  Cigarette smoking and risk of premature stroke in men and women. , 1986, British medical journal.

[7]  R. D'Agostino,et al.  Fibrinogen, cigarette smoking, and risk of cardiovascular disease: insights from the Framingham Study. , 1987, American heart journal.

[8]  D. Reed,et al.  Risk of stroke in male cigarette smokers. , 1986, The New England journal of medicine.

[9]  K. M. Peddecord,et al.  The association between cerebrovascular disease and smoking: a case-control study. , 1986, Neuroepidemiology.

[10]  R. D'Agostino,et al.  Fibrinogen and risk of cardiovascular disease. The Framingham Study. , 1987, JAMA.

[11]  R. Doll,et al.  Mortality in relation to smoking: 22 years' observations on female British doctors. , 1980, British medical journal.

[12]  F. Bianchi,et al.  Italian Multicenter Study on Reversible Cerebral Ischemic Attacks: III - Influence of Age and Risk Factors on Cerebrovascular Atheroclerosis , 1984, Stroke.

[13]  R. Paffenbarger,et al.  Chronic disease in former college students. XI. Early precursors of nonfatal stroke. , 1971, American journal of epidemiology.

[14]  J. Kurtzke,et al.  Epidemiology of Cerebrovascular Disease , 1969 .

[15]  W. Kannel,et al.  Death and coronary attacks in men after giving up cigarette smoking. A report from the Framingham study. , 1974, Lancet.

[16]  P. Wolf,et al.  Subarachnoid and intracerebral hemorrhage , 1984, Neurology.