Current smoking is associated with extracranial carotid atherosclerotic stenosis but not with intracranial large artery disease

Abstract

BackgroundAccumulating evidence has shown that cigarette smoking is an important risk factor for ischemic stroke. However, it is not clear about the potential mechanisms through which cigarette smoking affects stroke risk. In the study, we aimed to investigate the relationship between cigarette smoking and the occurrence of extracranial (ECAS) and intracranial atherosclerotic stenosis (ICAS).MethodsWe analyzed patients enrolled in the Chinese intracranial atherosclerosis (CICAS), which was a prospective, multicenter, hospital-based cohort study. Smoking status was classified into never, former and current smoking. For those patients with current smoking, data on time duration (year) and extent (the number of cigarette smoked per day) was recorded and pack year of smoking was calculated. ICAS was evaluated with 3-dimentional time-of-flight MRA and ECAS was evaluated with cervical ultrasonography or contrast-enhanced MRA. Multivariable Logistic regression was performed to identify the association between smoking status and the occurrence of ECAS and ICAS.ResultsA total of 2656 patients (92.7%) of acute ischemic stroke and 208 (7.3%) of transient ischemic attack were analyzed. The mean age was 61.9 ± 11.2 and 67.8% were male. There were 141 (4.9%) patients had only ECAS, 1074 (37.5%) had only ICAS, and 261 (9.1%) had both ECAS and ICAS. Current smoking was significantly associated with the occurrence of ECAS (adjusted OR = 1.47, 95% CI = 1.09–1.99, P < 0.01). In addition, with 1 year of smoking increment, the risk of ECAS increased by 1.1% (adjusted OR = 1.011; 95% CI = 1.003–1.019; P = 0.005); with one cigarette smoked per day increment, the risk of ECAS increased by 1.0% (adjusted OR = 1.010; 95% CI = 1.001–1.020; P = 0.03); and with one pack year of smoking increment, the risk of ECAS increased by 0.7% (adjusted OR = 1.007; 95% CI = 1.002–1.012; P < 0.01). However, no significant association was found between smoking status and the occurrence of ICAS.ConclusionA dose–response relationship was identified between cigarette smoking and the occurrence of ECAS, but not ICAS. Further studies on molecular mechanisms were warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-017-0873-7) contains supplementary material, which is available to authorized users.

Atherosclerotic calcification in major vessel beds in chronic obstructive pulmonary disease: The Rotterdam Study

“…A possible explanation for this finding may be due to the specific pathology of atherosclerosis in these vessel beds. Atherosclerosis in the extracranial carotid arteries is thought to be more susceptible to cigarette smoking and systemic inflammation, whereas atherosclerosis in the intracranial carotid arteries in other studies has been associated with female sex and metabolic syndrome [26][27][28][29][30]. The sex-stratified analysis did not support that mechanisms underlying intracranial artery atherosclerosis in women in general would be further aggravated in women with COPD.…”

<p>Role of cigarette smoking in the development of ischemic stroke and its subtypes: a Mendelian randomization study</p>

“…In the present study, we found that genetic predisposition to smoking is associated with a 1.52-fold higher risk of LV-IS, which is consistent with some recent observational studies. For instance, a cohort study including 2656 patients with acute IS and 208 patients with transient ischemic attack found that smoking was significantly associated with the risk of extracranial atherosclerotic stenosis, which is one of the most common causes of LV-IS (OR 1.47, 95% CI 1.09–1.99) 25. However, the underlying mechanisms between smoking and LV-IS remain uncertain.…”

Factores de riesgo cardiovascular en pacientes intervenidos de estenosis carotídea en el Hospital 12 de Octubre

“…En cuanto a la dislipemia, es un factor de riesgo creciente para el desarrollo de enfermedad ateromatosa. Los datos del estudio LIPID sobre el tratamiento con estatinas muestran una reducción del riesgo de ACV de entre un 25% y el 32% en los pacientes tratados (24). La diabetes mellitus es otro factor de riesgo importante para el desarrollo de enfermedad ateromatosa.…”

“…El análisis comparativo entre factores de riesgo y sexo muestra una correlación significativa en el hábito de fumar y ser hombre. El estudio de Ruijun et al (24), establece que el hábito de fumar es un factor de riesgo asociado a la formación de estenosis carotídea extracraneal, incrementándose el riesgo en 1,1% por cada año de consumo de tabaco.…”