Smoking rates falling in adults, but stroke survivors' smoking rates remain steady

While the rate of Americans who smoke tobacco has fallen steadily and significantly over the last two decades, the rate of stroke survivors who smoke has not changed significantly, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2020—Feb. 19-21 in Los Angeles, a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

"Smoking cessation should be at the top of the list of preventive measures for people with a prior stroke, because prior research shows that those who continue smoking are more likely to die, or have a heart attack or second stroke," said Neal S. Parikh, M.D., lead author of the study and assistant professor of neurology at Weill Cornell Medicine in New York City. "The importance of smoking cessation should be stressed alongside the importance of taking blood-thinning medication (such as aspirin, clopidogrel or an anticoagulant) and cholesterol-lowering medication as prescribed, and ensuring blood pressure is controlled."

The researchers examined data from more than 49,000 adults age 20 or older who participated in the National Health and Nutritional Examination Surveys between 1996 and 2016. Of those, one in 37 people reported a prior stroke (average age 65, 57% women). Comparing active smoking between those with a prior stroke and the overall population, the researchers found:

Over the time period analyzed, 24% of stroke survivors reported active smoking, compared with 22% of all participants;

Between the 1999-2000 survey and the 2015-16 survey, the overall percentage of active smokers in the overall population declined steadily and significantly, from roughly 25% to 19%, respectively; and

In contrast, the percentage of stroke survivors who smoked did not change significantly, going from roughly 23% to 26%, respectively, in the two surveys.

"The persistent rate of smoking among stroke survivors, who should be motivated to quit, speaks to the highly addictive nature of nicotine. It's important for stroke survivors to know that several effective, FDA-approved medications to assist patients with smoking cessation are available. Patients should ask their health care providers to help them quit smoking and seek smoking cessation programs and resources through their cities and states where available," Parikh said.

The results are similar to a 2015 analysis on heart attack patients from the same national survey, which found that the proportion of patients with a prior heart attack who smoked did not decrease between 1999 and 2012.

"The lack of progress in smoking cessation among stroke survivors reinforces the need for aggressive cessation interventions," Parikh said.

This study is limited by the small number of patients reporting prior stroke in the survey. In addition, the survey relied on the participants self-reporting of prior strokes, so some people with minor strokes may have been missed.

"This study, while based on self-reported data, raises concerns about an important gap in the completeness of secondary prevention efforts for stroke in the U.S. While data from the American Heart Association's Tobacco Center for Regulatory Science and from others indicates that many of the public are aware that smoking is a risk factor for cardiovascular events including stroke, these disappointing figures make it clear that we have more work to do to increase this knowledge, and perhaps more importantly, to help patients turn that knowledge into effective action for smoking cessation," said Rose Marie Robertson, M.D., co-principal investigator of the Center, who was not involved in this study. "Multi-episode counseling, FDA-approved nicotine replacement therapy and medications to address cravings, when indicated, should be offered during rehabilitation to all stroke survivors who smoke or use other tobacco products."