Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case-control study.
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Wang Xingyu, Liu Xin, O'Donnell Martin J, McQueen Matthew, Sniderman Allan, Pare Guillaume, Hankey Graeme J, Rangarajan Sumathy, Chin Siu Lim, Rao-Melacini Purnima, Ferguson John, Xavier Denis, Zhang Hongye, Liu Lisheng, Pais Prem, Lopez-Jaramillo Patricio, Damasceno Albertino, Langhorne Peter, Rosengren Annika, Dans Antonio L, Elsayed Ahmed, Avezum Alvaro, Mondo Charles, Judge Conor, Diener Hans-Christoph, Ryglewicz Danuta, Czlonkowska Anna, Pogosova Nana, Weimar Christian, Iqbal Romana, Diaz Rafael, Yusoff Khalid, Yusufali Afzalhussein, Oguz Aytekin, Penaherrera Ernesto, Lanas Fernando, Ogah Okechukwu S, Ogunniyi A, Iversen Helle K, Malaga German, Rumboldt Zvonko, Oveisgharan Shahram, Al Hussain Fawaz, Nilanont Yongchai, Yusuf Salim, INTERSTROKE Investigators
Аннотация
METHODS: The INTERSTROKE study is a case-control study of acute first stroke and was undertaken with 13,462 stroke cases and 13,488 controls recruited between January 11, 2007 and August 8, 2015 in 32 countries worldwide. Association of risk of tobacco use and ETS exposure were analysed with overall stroke, ischemic and intracerebral hemorrhage (ICH), and with TOAST etiological stroke subtypes (large vessel, small vessel, cardioembolism, and undetermined).
FINDINGS: Current smoking was associated with an increased risk of all stroke (odds ratio [OR] 1.64, 95% CI 1.46-1.84), and had a stronger association with ischemic stroke (OR 1.85, 95% CI 1.61-2.11) than ICH (OR 1.19 95% CI 1.00-1.41). The OR and PAR of stroke among current smokers varied significantly between regions and income levels with high income countries (HIC) having the highest odds (OR 3.02 95% CI 2.24-4.10) and PAR (18.6%, 15.1-22.8%). Among etiological subtypes of ischemic stroke, the strongest association of current smoking was seen for large vessel stroke (OR 2.16, 95% CI 1.63-2.87) and undetermined cause (OR 1.97, 95% CI 1.55-2.50). Both filtered (OR 1.73, 95% CI 1.50-1.99) and non-filtered (OR 2.59, 95% CI 1.79-3.77) cigarettes were associated with stroke risk. ETS exposure increased the risk of stroke in a dose-dependent manner, exposure for more than 10 h per week increased risk for all stroke (OR 1.95, 95% CI 1.69-2.27), ischemic stroke (OR 1.89, 95% CI 1.59-2.24) and ICH (OR 2.00, 95% CI 1.60-2.50).
INTERPRETATION: There are significant variations in the magnitude of risk and PAR of stroke according to the types of tobacco used, active and ETS exposure, and countries with different income levels. Specific strategies to discourage tobacco use by any form and to build a smoke free environment should be implemented to ease the global burden of stroke.
FUNDING: The Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MERCK, Sharp and Dohme, Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke.