0
January 13, 1993, Vol 269, No. 2 >
ARTICLE | January 13, 1993

Smoking Cessation and Decreased Risk of Stroke in Women FREE

Ichiro Kawachi, MB, ChB; Graham A. Colditz, MB; Meir J. Stampfer, MD; Walter C. Willett, MD; JoAnn E. Manson, MD; Bernard Rosner, PhD; Frank E. Speizer, MD; Charles H. Hennekens, MD
[+] Author Affiliations

Reprint requests to Channing Laboratory, 180 Long-wood Ave, Boston, MA 02115-5899 (Dr Kawachi).


JAMA. 1993;269(2):232-236. doi:10.1001/jama.1993.03500020066033
Text Size: A A A
Published online
Article
References

Objective.  —To prospectively examine the relationship of time since stopping smoking with risk of stroke in middle-aged women.

Design.  —An ongoing prospective cohort of women with 12 years' follow-up data (1976 to 1988), in which information on smoking habits was updated every 2 years by postal questionnaire.

Population Studied.  —A total of 117 006 female registered nurses aged 30 to 55 years in 1976 and free of coronary heart disease, stroke, and cancer at baseline.

Main Outcome Measures.  —Incident strokes (fatal and nonfatal), further subdivided into ischemic stroke, subarachnoid hemorrhage, and cerebral hemorrhage.

Results.  —The age-adjusted relative risk of total stroke among current smokers compared with never smokers was 2.58 (95% confidence interval, 2.08 to 3.19). The corresponding relative risk among former smokers was 1.34 (95% confidence interval, 1.04 to 1.73). For total and ischemic stroke, the excess risks among former smokers largely disappeared from 2 to 4 years after cessation. The same patterns of decline were observed regardless of number of cigarettes smoked, the age at starting, or the presence of other risk factors for stroke.

Conclusions.  —The risk of suffering a stroke among cigarette smokers declines soon after cessation and the benefits are independent of the age at starting and the number of cigarettes smoked per day.(JAMA. 1993;269:232-236)

REFERENCES

1 +
Shinton R, Beevers G.  Meta-analysis of relation between cigarette smoking and stroke. BMJ . 1989;; 298:789-794.
2 +
Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion. The Health Benefits of Smoking Cessation . Rockville, Md: Public Health Service, Centers for Disease Control, US Dept of Health and Human Services; 1990;. US Dept of Health and Human Services publication CDC 90-8416.
3 +
Donnan GA, McNeil JJ, Adena MA, Doyle AE, O'Malley HM, Neill GC.  Smoking as a risk factor for cerebral ischaemia. Lancet . 1989;;2:643-647.
4 +
Wolf PA, D'Agostino RB, Kannel WB, Bonita R, Belanger AJ.  Cigarette smoking as a risk factor for stroke: the Framingham Study. JAMA . 1988;;259: 1025-1029.
5 +
Colditz GA, Bonita R, Stampfer MJ, et al.  Cigarette smoking and risk of stroke in middle-aged women. N Engl J Med . 1988;;318:937-941.
6 +
Hennekens CH, Speizer FE, Rosner B, Bain CJ, Belanger C, Peto R.  Use of permanent hair dyes and cancer among registered nurses. Lancet . 1979;; 1:1301-1303.
7 +
Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH.  A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med . 1985;;313:1044-1049.
8 +
Colditz GA, Willett WC, Stampfer MJ, et al.  The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire. Int J Epidemiol . 1987;;16:392-398.
9 +
Giovannucci E, Colditz GA, Stampfer MJ, et al.  The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol . 1991;;133:810-817.
10 +
Walker AE, Robins M, Weinfeld FD.  The National Survey of Stroke: clinical findings. Stroke . 1981;;12( (suppl I) ):I13-I44.
11 +
Stampfer MJ, Willett WC, Speizer FE, et al.  Test of the National Death Index. Am J Epidemiol . 1984;;119:837-839.
12 +
Miettinen O.  Estimation and estimability in case-referent studies. Am J Epidemiol . 1976;;103:226-235.
13 +
Myers AH, Rosner B, Abbey H, et al.  Smoking behavior among participants in the Nurses' Health Study. Am J Public Health . 1987;;77:628-630.
14 +
Gill JS, Shipley MJ, Tsementzis SA, et al.  Cigarette smoking: a risk factor for hemorrhagic and nonhemorrhagic stroke. Arch Intern Med . 1989;; 149:2053-2057.
15 +
Kannel WB, D'Agostino RB, Belanger AL.  Fibrinogen, cigarette smoking and risk of cardiovascular disease: insights from the Framingham Study. Am Heart J . 1987;;113:1006-1010.
16 +
Levine PH.  An acute effect of cigarette smoking on platelet function: a possible link between smoking and arterial thrombosis. Circulation . 1973;; 48:619-623.
17 +
Rogers RL, Meyer JS, Judd BW, Mortel KF.  Abstention from cigarette smoking improves cerebral perfusion among elderly chronic smokers. JAMA . 1985;;253:2970-2974.
18 +
Ballantyne D, Devine BL, Fife R.  Interrelation of age, obesity, cigarette smoking, and blood pressure in hypertensive patients. Clin Sci Mol Med . 1978;;55:333-365.
19 +
Cellina GU, Honour AJ, Littler WA.  Direct arterial pressure, heart rate, and electrocardiogram during cigarette smoking in unrestricted patients. Am Heart J . 1975;;89:18-25.
20 +
Kubota K, Yamaguchi T, Abe Y, Fujiwara T, Hatazawa J, Matsuzawa T.  Effects of smoking on regional cerebral blood flow in neurologically normal subjects. Stroke . 1983;;14:720-724.
21 +
Longstreth WT, Koepsell TD, Yerby MS, van Belle G.  Risk factors for subarachnoid hemorrhage. Stroke . 1985;;16:377-385.
22 +
Bell BA, Symon L.  Smoking and subarachnoid hemorrhage. BMJ . 1979;;1:577-578.
23 +
Taha A, Ball KP, Illingworth RD.  Smoking and subarachnoid hemorrhage. J R Soc Med . 1982;;75: 332-335.
24 +
LaCroix AZ, Lang J, Scherr P, et al.  Smoking and mortality among older men and women in three communities. N Engl J Med . 1991;;324:1619-1625.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Shinton R, Beevers G.  Meta-analysis of relation between cigarette smoking and stroke. BMJ . 1989;; 298:789-794.
2 +
Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion. The Health Benefits of Smoking Cessation . Rockville, Md: Public Health Service, Centers for Disease Control, US Dept of Health and Human Services; 1990;. US Dept of Health and Human Services publication CDC 90-8416.
3 +
Donnan GA, McNeil JJ, Adena MA, Doyle AE, O'Malley HM, Neill GC.  Smoking as a risk factor for cerebral ischaemia. Lancet . 1989;;2:643-647.
4 +
Wolf PA, D'Agostino RB, Kannel WB, Bonita R, Belanger AJ.  Cigarette smoking as a risk factor for stroke: the Framingham Study. JAMA . 1988;;259: 1025-1029.
5 +
Colditz GA, Bonita R, Stampfer MJ, et al.  Cigarette smoking and risk of stroke in middle-aged women. N Engl J Med . 1988;;318:937-941.
6 +
Hennekens CH, Speizer FE, Rosner B, Bain CJ, Belanger C, Peto R.  Use of permanent hair dyes and cancer among registered nurses. Lancet . 1979;; 1:1301-1303.
7 +
Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH.  A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med . 1985;;313:1044-1049.
8 +
Colditz GA, Willett WC, Stampfer MJ, et al.  The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire. Int J Epidemiol . 1987;;16:392-398.
9 +
Giovannucci E, Colditz GA, Stampfer MJ, et al.  The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol . 1991;;133:810-817.
10 +
Walker AE, Robins M, Weinfeld FD.  The National Survey of Stroke: clinical findings. Stroke . 1981;;12( (suppl I) ):I13-I44.
11 +
Stampfer MJ, Willett WC, Speizer FE, et al.  Test of the National Death Index. Am J Epidemiol . 1984;;119:837-839.
12 +
Miettinen O.  Estimation and estimability in case-referent studies. Am J Epidemiol . 1976;;103:226-235.
13 +
Myers AH, Rosner B, Abbey H, et al.  Smoking behavior among participants in the Nurses' Health Study. Am J Public Health . 1987;;77:628-630.
14 +
Gill JS, Shipley MJ, Tsementzis SA, et al.  Cigarette smoking: a risk factor for hemorrhagic and nonhemorrhagic stroke. Arch Intern Med . 1989;; 149:2053-2057.
15 +
Kannel WB, D'Agostino RB, Belanger AL.  Fibrinogen, cigarette smoking and risk of cardiovascular disease: insights from the Framingham Study. Am Heart J . 1987;;113:1006-1010.
16 +
Levine PH.  An acute effect of cigarette smoking on platelet function: a possible link between smoking and arterial thrombosis. Circulation . 1973;; 48:619-623.
17 +
Rogers RL, Meyer JS, Judd BW, Mortel KF.  Abstention from cigarette smoking improves cerebral perfusion among elderly chronic smokers. JAMA . 1985;;253:2970-2974.
18 +
Ballantyne D, Devine BL, Fife R.  Interrelation of age, obesity, cigarette smoking, and blood pressure in hypertensive patients. Clin Sci Mol Med . 1978;;55:333-365.
19 +
Cellina GU, Honour AJ, Littler WA.  Direct arterial pressure, heart rate, and electrocardiogram during cigarette smoking in unrestricted patients. Am Heart J . 1975;;89:18-25.
20 +
Kubota K, Yamaguchi T, Abe Y, Fujiwara T, Hatazawa J, Matsuzawa T.  Effects of smoking on regional cerebral blood flow in neurologically normal subjects. Stroke . 1983;;14:720-724.
21 +
Longstreth WT, Koepsell TD, Yerby MS, van Belle G.  Risk factors for subarachnoid hemorrhage. Stroke . 1985;;16:377-385.
22 +
Bell BA, Symon L.  Smoking and subarachnoid hemorrhage. BMJ . 1979;;1:577-578.
23 +
Taha A, Ball KP, Illingworth RD.  Smoking and subarachnoid hemorrhage. J R Soc Med . 1982;;75: 332-335.
24 +
LaCroix AZ, Lang J, Scherr P, et al.  Smoking and mortality among older men and women in three communities. N Engl J Med . 1991;;324:1619-1625.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems