Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case–control study
Issued Date
2024-04-01
Resource Type
eISSN
25895370
Scopus ID
2-s2.0-85188146715
Journal Title
eClinicalMedicine
Volume
70
Rights Holder(s)
SCOPUS
Bibliographic Citation
eClinicalMedicine Vol.70 (2024)
Suggested Citation
Wang X., Liu X., O'Donnell M.J., McQueen M., Sniderman A., Pare G., Hankey G.J., Rangarajan S., Chin S.L., Rao-Melacini P., Ferguson J., Xavier D., Zhang H., Liu L., Pais P., Lopez-Jaramillo P., Damasceno A., Langhorne P., Rosengren A., Dans A.L., Elsayed A., Avezum A., Mondo C., Judge C., Diener H.C., Ryglewicz D., Czlonkowska A., Pogosova N., Weimar C., Iqbal R., Diaz R., Yusoff K., Yusufali A., Oguz A., Penaherrera E., Lanas F., Ogah O.S., Ogunniyi A., Iversen H.K., Malaga G., Rumboldt Z., Oveisgharan S., Al Hussain F., Nilanont Y., Yusuf S. Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case–control study. eClinicalMedicine Vol.70 (2024). doi:10.1016/j.eclinm.2024.102515 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/97764
Title
Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case–control study
Author(s)
Wang X.
Liu X.
O'Donnell M.J.
McQueen M.
Sniderman A.
Pare G.
Hankey G.J.
Rangarajan S.
Chin S.L.
Rao-Melacini P.
Ferguson J.
Xavier D.
Zhang H.
Liu L.
Pais P.
Lopez-Jaramillo P.
Damasceno A.
Langhorne P.
Rosengren A.
Dans A.L.
Elsayed A.
Avezum A.
Mondo C.
Judge C.
Diener H.C.
Ryglewicz D.
Czlonkowska A.
Pogosova N.
Weimar C.
Iqbal R.
Diaz R.
Yusoff K.
Yusufali A.
Oguz A.
Penaherrera E.
Lanas F.
Ogah O.S.
Ogunniyi A.
Iversen H.K.
Malaga G.
Rumboldt Z.
Oveisgharan S.
Al Hussain F.
Nilanont Y.
Yusuf S.
Liu X.
O'Donnell M.J.
McQueen M.
Sniderman A.
Pare G.
Hankey G.J.
Rangarajan S.
Chin S.L.
Rao-Melacini P.
Ferguson J.
Xavier D.
Zhang H.
Liu L.
Pais P.
Lopez-Jaramillo P.
Damasceno A.
Langhorne P.
Rosengren A.
Dans A.L.
Elsayed A.
Avezum A.
Mondo C.
Judge C.
Diener H.C.
Ryglewicz D.
Czlonkowska A.
Pogosova N.
Weimar C.
Iqbal R.
Diaz R.
Yusoff K.
Yusufali A.
Oguz A.
Penaherrera E.
Lanas F.
Ogah O.S.
Ogunniyi A.
Iversen H.K.
Malaga G.
Rumboldt Z.
Oveisgharan S.
Al Hussain F.
Nilanont Y.
Yusuf S.
Author's Affiliation
Siriraj Hospital
Dubai Health Authority
Fundación Oftalmológica de Santander
National Medical Research Center for Therapy and Preventive Medicine
UCSI University
Estudios Clínicos Latinoamérica, Argentina
Universidad de la Frontera, Facultad de Medicina
National Research Institute for Family Planning, Beijing
Universidade Eduardo Mondlane
Institute of Psychiatry and Neurology, Warszawa
Hospital Luis Vernaza
Mulago Hospital
University of the Philippines College of Medicine
Universidad Peruana Cayetano Heredia
The Aga Khan University Hospital
Sahlgrenska Universitetssjukhuset
Instituto Dante Pazzanese de Cardiologia
University College Hospital, Ibadan
University of Limpopo
University of Galway
Hamilton Health Sciences
Universitätsklinikum Essen
University of Split
Rigshospitalet
Centre Universitaire de Santé McGill
St. John's Medical College
University of Glasgow
Alshaab Teaching Hospital
İstanbul Medeniyet Üniversitesi
Rush Alzheimer Disease Research Center in Chicago
Beijing Hypertension League Institute
Dubai Health Authority
Fundación Oftalmológica de Santander
National Medical Research Center for Therapy and Preventive Medicine
UCSI University
Estudios Clínicos Latinoamérica, Argentina
Universidad de la Frontera, Facultad de Medicina
National Research Institute for Family Planning, Beijing
Universidade Eduardo Mondlane
Institute of Psychiatry and Neurology, Warszawa
Hospital Luis Vernaza
Mulago Hospital
University of the Philippines College of Medicine
Universidad Peruana Cayetano Heredia
The Aga Khan University Hospital
Sahlgrenska Universitetssjukhuset
Instituto Dante Pazzanese de Cardiologia
University College Hospital, Ibadan
University of Limpopo
University of Galway
Hamilton Health Sciences
Universitätsklinikum Essen
University of Split
Rigshospitalet
Centre Universitaire de Santé McGill
St. John's Medical College
University of Glasgow
Alshaab Teaching Hospital
İstanbul Medeniyet Üniversitesi
Rush Alzheimer Disease Research Center in Chicago
Beijing Hypertension League Institute
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking. In this study we aimed to explore the association of current tobacco use with different types of tobacco exposure and environmental tobacco smoke (ETS) exposure on the risk of stroke and stroke subtypes, and by regions and country income levels. 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.