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Abstract
Objective: To assess whether smoking cessation after an ischemic stroke or TIA improves outcomes compared to continued smoking.
Methods: We conducted a prospective observational cohort study of 3,876 nondiabetic men and women enrolled in the Insulin Resistance Intervention After Stroke (IRIS) trial who were randomized to pioglitazone or placebo within 180 days of a qualifying stroke or TIA and followed up for a median of 4.8 years. A tobacco use history was obtained at baseline and updated during annual interviews. The primary outcome, which was not prespecified in the IRIS protocol, was recurrent stroke, myocardial infarction (MI), or death. Cox regression models were used to assess the differences in stroke, MI, and death after 4.8 years, with correction for adjustment variables prespecified in the IRIS trial: age, sex, stroke (vs TIA) as index event, history of stroke, history of hypertension, history of coronary artery disease, and systolic and diastolic blood pressures.
Results: At the time of their index event, 1,072 (28%) patients were current smokers. By the time of randomization, 450 (42%) patients had quit smoking. Among quitters, the 5-year risk of stroke, MI, or death was 15.7% compared to 22.6% for patients who continued to smoke (adjusted hazard ratio 0.66, 95% confidence interval 0.48–0.90).
Conclusion: Cessation of cigarette smoking after an ischemic stroke or TIA was associated with significant health benefits over 4.8 years in the IRIS trial cohort.
GLOSSARY
- ARR=
- absolute risk reduction;
- CI=
- confidence interval;
- HR=
- hazard ratio;
- IRIS=
- Insulin Resistance Intervention After Stroke;
- MI=
- myocardial infarction;
- RRR=
- relative risk reduction
Footnotes
Coinvestigators are listed at Neurology.org
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
Editorial, page 1656
- Received March 27, 2017.
- Accepted in final form July 14, 2017.
- © 2017 American Academy of Neurology
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