Smoking and Risk of Hemorrhagic Stroke in Women

Background and Purpose— Several studies established smoking as a risk factor for ischemic stroke and subarachnoid hemorrhage (SAH) in men and women. A recent study added smoking as a risk factor for intracerebral hemorrhage (ICH) in men. In contrast, the impact of smoking on ICH in women is less clear. Methods— Prospective cohort study among 39 783 US women participating in the Women’s Health Study. Smoking habits and stroke occurrence were self-reported. Stroke cases were confirmed by medical record review. We used Cox proportional hazards model to evaluate the association of smoking with risk of total hemorrhagic stroke, ICH, and SAH. We categorized smoking into never, past, and current smokers of <15 and ≥15 cigarettes per day. Results— During 9 years of follow up, a total of 70 hemorrhagic strokes occurred, of which 40 were ICH and 29 were SAH. Never smokers and past smokers had equal rates of ICH and SAH. Current smokers of <15 cigarettes per day had a multivariable-adjusted relative risk (RR) of 1.93 (95% CI, 0.75 to 5.02) for total hemorrhagic stroke, 2.15 (95% CI, 0.62 to 7.43) for ICH, and 1.70 (95% CI, 0.38 to 7.60) for SAH. Women who smoked ≥15 cigarettes per day had RR of 3.29 (95% CI, 1.72 to 6.29) for total hemorrhagic stroke, 2.67 (95% CI, 1.04 to 6.90) for ICH, and 4.02 (95% CI, 1.63 to 9.89) for SAH compared with never smokers. Conclusions— This prospective study indicates an increased risk of total hemorrhagic stroke, ICH, and SAH in women who are current cigarette smokers. The risk increases with the amount of cigarettes smoked.

[1]  J. Buring,et al.  Smoking and the Risk of Hemorrhagic Stroke in Men , 2003, Stroke.

[2]  J. Buring,et al.  Interobserver Agreement in the Classification of Stroke in the Women’s Health Study , 2003, Stroke.

[3]  A. Qureshi,et al.  Outcome following intracerebral hemorrhage and subarachnoid hemorrhage , 2002, Neurological research.

[4]  S. Juvela,et al.  Factors Affecting Formation and Growth of Intracranial Aneurysms: A Long-Term Follow-Up Study , 2001, Stroke.

[5]  A. Bruno,et al.  Risk Factors for Intracerebral and Subarachnoid Hemorrhage among Hispanics and Non-Hispanic Whites in a New Mexico Community , 2000, Neuroepidemiology.

[6]  S. Juvela,et al.  Risk factors for multiple intracranial aneurysms. , 2000, Stroke.

[7]  N. Cook,et al.  Baseline characteristics of participants in the Women's Health Study. , 2000, Journal of women's health & gender-based medicine.

[8]  H. Iso,et al.  [Cohort study on risk factors for subarachnoid hemorrhage among Japanese men and women]. , 1999, Nihon eiseigaku zasshi. Japanese journal of hygiene.

[9]  R. Sacco,et al.  Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study. , 1998, American journal of epidemiology.

[10]  G. Howard,et al.  Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study. , 1998, JAMA.

[11]  R. Janssen,et al.  Intracerebral hemorrhage in blacks. Risk factors, subtypes, and outcome. , 1997, Stroke.

[12]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[13]  D. Jacobs,et al.  Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program. , 1996, Stroke.

[14]  Daniel B. Mark,et al.  TUTORIAL IN BIOSTATISTICS MULTIVARIABLE PROGNOSTIC MODELS: ISSUES IN DEVELOPING MODELS, EVALUATING ASSUMPTIONS AND ADEQUACY, AND MEASURING AND REDUCING ERRORS , 1996 .

[15]  S. Juvela,et al.  Risk factors for spontaneous intracerebral hemorrhage. , 1995, Stroke.

[16]  Diane C. Thompson,et al.  The validity of self-reported smoking: a review and meta-analysis. , 1994, American journal of public health.

[17]  S. Juvela,et al.  Cigarette Smoking and Alcohol Consumption as Risk Factors for Aneurysmal Subarachnoid Hemorrhage , 1993, Stroke.

[18]  R. Fogelholm,et al.  Cigarette smoking and risk of primary intracerebral haemorrhage , 1993, Acta neurologica Scandinavica.

[19]  B Rosner,et al.  Smoking cessation and decreased risk of stroke in women. , 1993, JAMA.

[20]  M. Posada de la Paz,et al.  CLINICAL FINDINGS , 1978, WHO regional publications. European series.

[21]  M. Shipley,et al.  Cigarette Smoking: A Risk Factor for Hemorrhagic and Nonhemorrhagic Stroke , 1989 .

[22]  W. Willett,et al.  Cigarette smoking and risk of stroke in middle-aged women. , 1988, The New England journal of medicine.

[23]  W. Willett,et al.  Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. , 1986, American journal of epidemiology.

[24]  F. D. Weinfeld,et al.  The National Survey of Stroke. Clinical findings. , 1981, Stroke.

[25]  W. Hall,et al.  Compliance with dietary guidelines affects capillary recruitment in healthy middle-aged men and women , 2016, European Journal of Nutrition.

[26]  D.,et al.  Regression Models and Life-Tables , 2022 .