Characterization of increased cryptogenic ischemic stroke risk from smoking

1. Smoking had a strong association with young cryptogenic ischemic stroke that was more pronounced in men and peaked in the 45-49 age group

2. Smoking greater than 20 pack years was necessary to see an association after adjusting for confounding variables

Evidence Rating Level: 2 (Good) 

This multicenter case-control study examined the association between smoking and cryptogenic ischemic stroke (CIS) in young adults aged 18–49, using data from the SECRETO study. As CIS accounts for up to 28% of strokes in this age group and smoking is a modifiable vascular risk factor, the study aimed to clarify smoking’s role in young CIS incidence. A total of 546 young patients with CIS (47.3% female) and 546 age- and sex-matched controls were analyzed. Smoking status and intensity (pack years) were assessed through standardized questionnaires, and conditional logistic regression adjusted for education level and vascular risk factors (hypertension, diabetes, obesity, alcohol use, etc.) was used. There was a strong association between smoking and young CIS (adjusted OR 2.39, 95% CI 1.65–3.47). The risk was more pronounced in men (OR 3.34) than women (OR 1.65) and peaked in the 45–49 age group (OR 3.77). Heavy smoking (>20 pack years) showed the strongest link to CIS (OR 4.30), especially in men (OR 6.97). Notably, no significant association emerged in women or those smoking fewer than 20 pack years after adjusting for confounders. These findings highlight smoking as an independent risk factor for young CIS, with risk intensifying with smoking intensity and age, particularly among men. The study underscores the need for targeted smoking cessation strategies and more research into sex-specific mechanisms underlying CIS.

Click to read the study in Neurology

Image: PD

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