Association of Smoking and Young Cryptogenic Ischemic Stroke

Ferdinand, Phillip; Bajpai, Ram; Von Sarnowski, Bettina; Ylikotila, Pauli; Zedde, Marialuisa; Sarkanen, Tomi; Ryliskiene, Kristina; Martinez-Majander, Nicolas; Juhani Tulkki, Lauri; Licenik, Radim; Kõrv, Janika; Kõrv, Liisa; Pezzini, Alessandro; Catarina Fonseca, Ana; Martínez-Sánchez, Patricia; Amaya-Pascasio, Laura; Yeşilot, Nilüfer; Waje-Andreassen, Ulrike; Fromm, Annette; Huhtakangas, Juha; Jäkälä, Pekka; Kantanen, Anne-Mari; Redfors, Petra; Sinisalo, Juha; Gerdts, Eva; Putaala, Jukka; Roffe, Christine

Abstract

Background and Objectives
The incidence of ischemic stroke in the young is increasing and driven by cryptogenic strokes. Smoking is a well-documented risk factor with a high prevalence in young ischemic strokes. We sought to determine the association between smoking and young cryptogenic ischemic stroke (CIS) in a large multicenter case-control study.
Methods
In the Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) study, patients with CIS aged 18–49 years were prospectively recruited within 2 weeks of symptom onset from 19 European stroke centers. One sex-matched and age-matched (±5 years) stroke-free control was recruited per patient. Data on tobacco use and intensity of use, socioeconomic status, and comorbidities were collected using a standardized questionnaire. Conditional logistic regression with adjustment for low education status and vascular risk factors was used to assess the association between smoking and intensity of smoking and CIS.
Results
A total of 546 young patients with CIS (47.3% female) and their matched controls were included in the analysis. Univariate comparison between patients and controls showed a significant difference in low education status (55.6% vs 35.2%, p ≤ 0.001), hypertension (34.7% vs 26.8%, p ≤ 0.005), obesity (59.3% vs 44.4%, p ≤ 0.001), physical inactivity (29.4% vs 23.6%, p ≤ 0.02), smoking (32.8% vs 14.8%, p ≤ 0.001), and heavy alcohol use (13.7% vs 6.7%, p ≤ 0.001). Conditional logistic regression after adjustment showed an association between smoking and young CIS in the whole cohort with an odds ratio of 2.39 (95% CI 1.65–3.47), in men with 3.34 (1.91–5.84), and in all age groups—highest in the 45–49-year age group—with 3.77 (1.74–8.17). Analysis of smoking intensity by pack year showed the strongest association in the group with >20 pack years with an odds ratio of 4.30 (2.10–8.81), particularly in men (6.97 (2.58–18.82)) and the 45–49-year age group (4.91 (1.74–13.85)).
Discussion
Both smoking and high-intensity smoking were associated with CIS in the young, particularly in men and the 45–49-year age group.

Citation

Ferdinand, P., Bajpai, R., Von Sarnowski, B., Ylikotila, P., Zedde, M., Sarkanen, T., Ryliskiene, K., Martinez-Majander, N., Juhani Tulkki, L., Licenik, R., Kõrv, J., Kõrv, L., Pezzini, A., Catarina Fonseca, A., Martínez-Sánchez, P., Amaya-Pascasio, L., Yeşilot, N., Waje-Andreassen, U., Fromm, A., Huhtakangas, J., …Roffe, C. (2025). Association of Smoking and Young Cryptogenic Ischemic Stroke. Neurology Open Access, 1(1), 1-9. https://doi.org/10.1212/wn9.0000000000000003

• Journal Article Type: Article
• Acceptance Date: Jan 7, 2025
• Online Publication Date: Feb 19, 2025
• Publication Date: Feb 28, 2025
• Deposit Date: Feb 26, 2025
• Journal: Neurology Open Access
• Publisher: Wolters Kluwer
• Peer Reviewed: Peer Reviewed
• Volume: 1
• Issue: 1
• Article Number: e0003
• Pages: 1-9
• DOI: https://doi.org/10.1212/wn9.0000000000000003
• Public URL: https://keele-repository.worktribe.com/output/1078605