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Background and Purpose—There is a strong dose–response relationship between smoking and risk of ischemic stroke
in young women, but there are few data examining this association in young men. We examined the dose–response
relationship between the quantity of cigarettes smoked and the odds of developing an ischemic stroke in men under age
50 years.
Methods—The Stroke Prevention in Young Men Study is a population-based case–control study of risk factors for ischemic
stroke in men ages 15 to 49 years. The χ2 test was used to test categorical comparisons. Logistic regression models were
used to calculate the odds ratio for ischemic stroke occurrence comparing current and former smokers to never smokers.
In the first model, we adjusted solely for age. In the second model, we adjusted for potential confounding factors,
including age, race, education, hypertension, myocardial infarction, angina, diabetes mellitus, and body mass index.
Results—The study population consisted of 615 cases and 530 controls. The odds ratio for the current smoking group
compared with never smokers was 1.88. Furthermore, when the current smoking group was stratified by number of
cigarettes smoked, there was a dose–response relationship for the odds ratio, ranging from 1.46 for those smoking <11
cigarettes per day to 5.66 for those smoking 40+ cigarettes per day.
Conclusions—We found a strong dose–response relationship between the number of cigarettes smoked daily and ischemic
stroke among young men. Although complete smoking cessation is the goal, even smoking fewer cigarettes may reduce
the risk of ischemic stroke in young men. (Stroke. 2018;49:1276-1278. DOI: 10.1161/STROKEAHA.117.018859.)
Key Words: risk factors ◼ smoke ◼ smoking ◼ stroke ◼ tobacco products
Downloaded from http://ahajournals.org by on August 16, 2018
Methods
To minimize the possibility of unintentionally sharing information Statistical Methodology
that can be used to reidentify private information, a subset of the data Statistical analysis was conducted using SAS version 9.4. The
generated for this study is available at dbGaP and can be accessed at χ2 test was used to test categorical comparisons. Logistic regres-
https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_ sion models were used to calculate the odds ratio for IS occur-
id=phs000292.v1.p1. rence comparing smokers to never smokers. In the first model,
The Stroke Prevention in Young Men Study is a population-based we adjusted solely for age. In the second, fully-adjusted, model,
case–control study of risk factors for IS in men ages 15 to 49 years. we adjusted for potential confounding factors, including age,
All cases were recruited within 3 years of stroke between 2003 and race, education, hypertension, myocardial infarction, angina,
Received November 27, 2017; final revision received February 4, 2018; accepted February 26, 2018.
From the University of Maryland School of Medicine, Baltimore (J.M.); and Department of Neurology Baltimore Veterans Affairs Medical Center and
University of Maryland School of Medicine (J.W.C., C.A.C., J.G.M., M.S.P., M.A.W., S.J.K.).
Presented in part at the International Stroke Conference, Los Angeles, CA, January 24–26, 2018.
The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.
Correspondence to Janina Markidan, BA, University of Maryland School of Medicine, Bressler Research Bldg, 12-006, 655 W Baltimore St, Baltimore,
MD 21201. E-mail Janina.markidan@som.umaryland.edu
© 2018 American Heart Association, Inc.
Stroke is available at http://stroke.ahajournals.org DOI: 10.1161/STROKEAHA.117.018859
1276
Markidan et al Smoking and Risk of Ischemic Stroke in Young Men 1277
diabetes mellitus, and body mass index. Interaction terms were was 1.88 (95% confidence interval, 1.44–2.44). Furthermore,
used to examine potential effect modification by other risk factors. when the current smoking group was stratified by number of
Statistical tests were 2-tailed, and P<0.05 was considered statisti-
cigarettes smoked, there was a dose–response relationship for
cally significant.
Downloaded from http://ahajournals.org by on August 16, 2018
However, the similar findings in the Swedish study, derived 6. Tang JL, Morris JK, Wald NJ, Hole D, Shipley M, Tunstall-Pedoe H.
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Smoking rates among patients hospitalized for IS have been ing. A risk factor for cerebral infarction in young adults. Arch Neurol.
increasing.1 The clinical implications of our finding are, that 1990;47:693–698.
8. Falkstedt D, Wolff V, Allebeck P, Hemmingsson T, Danielsson AK.
while complete cessation of smoking is the goal, even reduc-
Cannabis, tobacco, alcohol use, and the risk of early stroke: a population-
ing the number of cigarettes smoked may have beneficial based cohort study of 45 000 Swedish Men. Stroke. 2017;48:265–270.
health effects. doi: 10.1161/STROKEAHA.116.015565.