Cessation of Smoking has been repeatedly shown to be a critical factor in the prophylaxis and aftercare of cardiovascular diseases, especially Stroke. But it had not been properly studied with a rigorous scientific study until now.
Kathrine Epstein et al. compared the rates of the composite outcome of stroke, myocardial infarction or death during a period of five years in a cohort of patients that had had a recent ischemic stroke or transient ischemic attack and who were still smoking or had quit. The IRIS protocol included high quality baseline data on smoking and follow-up data on outcomes.
The IRIS study recruited 3,876 non-diabetic individuals that had had a stroke or a TIA in the past six months into a study whether pigliotazone could reduce the recurrence of these events in a five year-period; in 2015 they started studying patients from 179 hospitals and clinics in 7 countries. They studied several lifestyle measures, including smoking cessation, in the beginning of the study and then in a follow-up contact four times per year.
At the baseline 1,490 individuals were classified as former smokers, 450 as quitters after the CVA and 622 continued to smoke for a median time of 40 years. After a median follow-up of almost five years, 60 patients of non-smokers had a stroke, a myocardial infarction of passed away. The mortality was higher in individuals that were still smoking. Only 7 deaths in the quitting group were related to a neoplasia compared to 21 for the smokers (1.5% versus 3.4%) There was a more modest effect in cerebrovascular disease (0.2% versus 1.6%) and heart disease (0.7% versus 1.6%) The relative-risk reduction (34%) and the absolute risk reduction (6.9 %) are comparable to other clinical treatments for secondary stroke prevention.
Physicians should talk clear to their stroke patients that do not quit smoking. “Listen, of 100 persons that do not give up puffing after what you had, 23 of them will most likely have another stroke, a myocardial infarction or even pass away after five years…Do you want to continue playing this lottery?”
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Don’t leave me alone.