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., …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: 2025-03
• 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