Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1989 Mar 25;298(6676):789–794. doi: 10.1136/bmj.298.6676.789

Meta-analysis of relation between cigarette smoking and stroke.

R Shinton 1, G Beevers 1
PMCID: PMC1836102  PMID: 2496858

Abstract

There is a lack of consensus among studies on the possible risks of stroke from cigarette smoking; because of this a meta-analysis was conducted. All published data on the association were sought and the relative risk for each study obtained whenever possible. The pooled relative risks were calculated by using estimates of the precision of the individual relative risks to weight their contribution to the meta-analysis. Thirty two separate studies were analysed. The overall relative risk of stroke associated with cigarette smoking was 1.5 (95% confidence interval 1.4 to 1.6). Considerable differences were seen in relative risks among the subtypes: cerebral infarction 1.9, cerebral haemorrhage 0.7, and subarachnoid haemorrhage 2.9. An effect of age on the relative risk was also noted; less than 55 years 2.9, 55-74 years 1.8, and greater than or equal to 75 years 1.1. A dose response between the number of cigarettes smoked and relative risk was noted, and there was a small increased risk in women compared with men. Ex-smokers under the age of 75 seemed to retain an appreciably increased risk of stroke (1.5); for all ages the relative risk in ex-smokers was 1.2. The meta-analysis provides strong evidence of an excess risk of stroke among cigarette smokers. Stroke should therefore be added to the list of diseases related to smoking.

Full text

PDF
789

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbott R. D., Yin Y., Reed D. M., Yano K. Risk of stroke in male cigarette smokers. N Engl J Med. 1986 Sep 18;315(12):717–720. doi: 10.1056/NEJM198609183151201. [DOI] [PubMed] [Google Scholar]
  2. Abu-Zeid H. A., Choi N. W., Maini K. K., Hsu P. H., Nelson N. A. Relative role of factors associated with cerebral infarction and cerebral hemorrhage. A matched pair case-control study. Stroke. 1977 Jan-Feb;8(1):106–112. doi: 10.1161/01.str.8.1.106. [DOI] [PubMed] [Google Scholar]
  3. Alderson M. R., Lee P. N., Wang R. Risks of lung cancer, chronic bronchitis, ischaemic heart disease, and stroke in relation to type of cigarette smoked. J Epidemiol Community Health. 1985 Dec;39(4):286–293. doi: 10.1136/jech.39.4.286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bell B. A., Symon L. Smoking and subarachnoid haemorrhage. Br Med J. 1979 Mar 3;1(6163):577–578. doi: 10.1136/bmj.1.6163.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bonita R. Cigarette smoking, hypertension and the risk of subarachnoid hemorrhage: a population-based case-control study. Stroke. 1986 Sep-Oct;17(5):831–835. doi: 10.1161/01.str.17.5.831. [DOI] [PubMed] [Google Scholar]
  6. Bonita R., Scragg R., Stewart A., Jackson R., Beaglehole R. Cigarette smoking and risk of premature stroke in men and women. Br Med J (Clin Res Ed) 1986 Jul 5;293(6538):6–8. doi: 10.1136/bmj.293.6538.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Colditz G. A., Bonita R., Stampfer M. J., Willett W. C., Rosner B., Speizer F. E., Hennekens C. H. Cigarette smoking and risk of stroke in middle-aged women. N Engl J Med. 1988 Apr 14;318(15):937–941. doi: 10.1056/NEJM198804143181501. [DOI] [PubMed] [Google Scholar]
  8. Doll R., Gray R., Hafner B., Peto R. Mortality in relation to smoking: 22 years' observations on female British doctors. Br Med J. 1980 Apr 5;280(6219):967–971. doi: 10.1136/bmj.280.6219.967. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Doll R., Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–1536. doi: 10.1136/bmj.2.6051.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fogelholm R., Aho K. Ischaemic cerebrovascular disease in young adults. 1. Smoking habits, use of oral contraceptives, relative weight, blood pressure and electrocardiographic findings. Acta Neurol Scand. 1973;49(4):415–427. doi: 10.1111/j.1600-0404.1973.tb01314.x. [DOI] [PubMed] [Google Scholar]
  11. Fogelholm R., Murros K. Cigarette smoking and subarachnoid haemorrhage: a population-based case-control study. J Neurol Neurosurg Psychiatry. 1987 Jan;50(1):78–80. doi: 10.1136/jnnp.50.1.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Fuller J. H., Shipley M. J., Rose G., Jarrett R. J., Keen H. Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. Br Med J (Clin Res Ed) 1983 Sep 24;287(6396):867–870. doi: 10.1136/bmj.287.6396.867. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gill J. S., Shipley M. J., Hornby R. H., Gill S. K., Beevers D. G. A community case-control study of alcohol consumption in stroke. Int J Epidemiol. 1988 Sep;17(3):542–547. doi: 10.1093/ije/17.3.542. [DOI] [PubMed] [Google Scholar]
  14. Hammond E. C. Smoking in relation to the death rates of one million men and women. Natl Cancer Inst Monogr. 1966 Jan;19:127–204. [PubMed] [Google Scholar]
  15. Herman B., Leyten A. C., van Luijk J. H., Frenken C. W., Op de Coul A. A., Schulte B. P. An evaluation of risk factors for stroke in a Dutch community. Stroke. 1982 May-Jun;13(3):334–339. doi: 10.1161/01.str.13.3.334. [DOI] [PubMed] [Google Scholar]
  16. Jick H., Porter J., Rothman K. J. Oral contraceptives and nonfatal stroke in healthy young women. Ann Intern Med. 1978 Jul;89(1):58–60. doi: 10.7326/0003-4819-89-1-58. [DOI] [PubMed] [Google Scholar]
  17. Johnson K. G., Yano K., Kato H. Cerebral vascular disease in Hiroshima, Japan. J Chronic Dis. 1967 Jul;20(7):545–559. doi: 10.1016/0021-9681(67)90085-9. [DOI] [PubMed] [Google Scholar]
  18. Khaw K. T., Barrett-Connor E., Suarez L., Criqui M. H. Predictors of stroke-associated mortality in the elderly. Stroke. 1984 Mar-Apr;15(2):244–248. doi: 10.1161/01.str.15.2.244. [DOI] [PubMed] [Google Scholar]
  19. Kiyohara Y., Ueda K., Hasuo Y., Fujii I., Yanai T., Wada J., Kawano H., Shikata T., Omae T., Fujishima M. Hematocrit as a risk factor of cerebral infarction: long-term prospective population survey in a Japanese rural community. Stroke. 1986 Jul-Aug;17(4):687–692. doi: 10.1161/01.str.17.4.687. [DOI] [PubMed] [Google Scholar]
  20. Kono S., Ikeda M., Tokudome S., Nishizumi M., Kuratsune M. Smoking and mortalities from cancer, coronary heart disease and stroke in male Japanese physicians. J Cancer Res Clin Oncol. 1985;110(2):161–164. doi: 10.1007/BF00402732. [DOI] [PubMed] [Google Scholar]
  21. Mackay A., Nias B. C. Strokes in the young and middle-aged: consequences to the family and to society. J R Coll Physicians Lond. 1979 Apr;13(2):106–112. [PMC free article] [PubMed] [Google Scholar]
  22. Molgaard C. A., Bartok A., Peddecord K. M., Rothrock J. The association between cerebrovascular disease and smoking: a case-control study. Neuroepidemiology. 1986;5(2):88–94. doi: 10.1159/000110818. [DOI] [PubMed] [Google Scholar]
  23. Nomura A., Comstock G. W., Kuller L., Tonascia J. A. Cigarette smoking and strokes. Stroke. 1974 Jul-Aug;5(4):483–486. doi: 10.1161/01.str.5.4.483. [DOI] [PubMed] [Google Scholar]
  24. Okada H., Horibe H., Yoshiyuki O., Hayakawa N., Aoki N. A prospective study of cerebrovascular disease in Japanese rural communities, Akabane and Asahi. Part 1: evaluation of risk factors in the occurrence of cerebral hemorrhage and thrombosis. Stroke. 1976 Nov-Dec;7(6):599–607. doi: 10.1161/01.str.7.6.599. [DOI] [PubMed] [Google Scholar]
  25. Oleckno W. A. The risk of stroke in young adults: an analysis of the contribution of cigarette smoking and alcohol consumption. Public Health. 1988 Jan;102(1):45–55. doi: 10.1016/s0033-3506(88)80009-x. [DOI] [PubMed] [Google Scholar]
  26. Ostfeld A. M. A review of stroke epidemiology. Epidemiol Rev. 1980;2:136–152. doi: 10.1093/oxfordjournals.epirev.a036219. [DOI] [PubMed] [Google Scholar]
  27. Ostfeld A. M., Shekelle R. B., Klawans H., Tufo H. M. Epidemiology of stroke in an elderly welfare population. Am J Public Health. 1974 May;64(5):450–458. doi: 10.2105/ajph.64.5.450. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Paffenbarger R. S., Jr, Wing A. L. Chronic disease in former college students. XI. Early precursors of nonfatal stroke. Am J Epidemiol. 1971 Dec;94(6):524–530. doi: 10.1093/oxfordjournals.aje.a121351. [DOI] [PubMed] [Google Scholar]
  29. Petitti D. B., Wingerd J., Pellegrin F., Ramcharan S. Risk of vascular disease in women. Smoking, oral contraceptives, noncontraceptive estrogens, and other factors. JAMA. 1979 Sep 14;242(11):1150–1154. [PubMed] [Google Scholar]
  30. Sacco R. L., Wolf P. A., Bharucha N. E., Meeks S. L., Kannel W. B., Charette L. J., McNamara P. M., Palmer E. P., D'Agostino R. Subarachnoid and intracerebral hemorrhage: natural history, prognosis, and precursive factors in the Framingham Study. Neurology. 1984 Jul;34(7):847–854. doi: 10.1212/wnl.34.7.847. [DOI] [PubMed] [Google Scholar]
  31. Salonen J. T., Puska P., Tuomilehto J., Homan K. Relation of blood pressure, serum lipids, and smoking to the risk of cerebral stroke. A longitudinal study in Eastern Finland. Stroke. 1982 May-Jun;13(3):327–333. doi: 10.1161/01.str.13.3.327. [DOI] [PubMed] [Google Scholar]
  32. Syrjänen J., Valtonen V. V., Iivanainen M., Kaste M., Huttunen J. K. Preceding infection as an important risk factor for ischaemic brain infarction in young and middle aged patients. Br Med J (Clin Res Ed) 1988 Apr 23;296(6630):1156–1160. doi: 10.1136/bmj.296.6630.1156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Taha A., Ball K. P., Illingworth R. D. Smoking and subarachnoid haemorrhage. J R Soc Med. 1982 May;75(5):332–335. doi: 10.1177/014107688207500508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Tanaka H., Ueda Y., Hayashi M., Date C., Baba T., Yamashita H., Shoji H., Tanaka Y., Owada K., Detels R. Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community. Stroke. 1982 Jan-Feb;13(1):62–73. doi: 10.1161/01.str.13.1.62. [DOI] [PubMed] [Google Scholar]
  35. Vandenbroucke J. P. Passive smoking and lung cancer: a publication bias? Br Med J (Clin Res Ed) 1988 Feb 6;296(6619):391–392. doi: 10.1136/bmj.296.6619.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Vessey M. P., Lawless M., Yeates D. Oral contraceptives and stroke: findings in a large prospective study. Br Med J (Clin Res Ed) 1984 Sep 1;289(6444):530–531. doi: 10.1136/bmj.289.6444.530-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Wald N. J., Nanchahal K., Thompson S. G., Cuckle H. S. Does breathing other people's tobacco smoke cause lung cancer? Br Med J (Clin Res Ed) 1986 Nov 8;293(6556):1217–1222. doi: 10.1136/bmj.293.6556.1217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Welin L., Svärdsudd K., Wilhelmsen L., Larsson B., Tibblin G. Analysis of risk factors for stroke in a cohort of men born in 1913. N Engl J Med. 1987 Aug 27;317(9):521–526. doi: 10.1056/NEJM198708273170901. [DOI] [PubMed] [Google Scholar]
  39. Wolf P. A., D'Agostino R. B., Kannel W. B., Bonita R., Belanger A. J. Cigarette smoking as a risk factor for stroke. The Framingham Study. JAMA. 1988 Feb 19;259(7):1025–1029. [PubMed] [Google Scholar]
  40. Yusuf S., Peto R., Lewis J., Collins R., Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985 Mar-Apr;27(5):335–371. doi: 10.1016/s0033-0620(85)80003-7. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES