Even After Stroke, Many Smokers Still Light Up

THURSDAY, Feb. 13, 2020 — While fewer Americans are smoking these days, the habit has remained stubbornly persistent among stroke survivors, new research shows.

The researchers found that the prevalence of smoking among U.S. stroke survivors has not improved since 1999 and, as of 2016, stood at 26%.

That’s in contrast to the trend among Americans in general, who are gradually leaving cigarettes behind. Between 1999 and 2016, the study found, the smoking rate among the overall population fell from about 25% to 19%.

The findings are concerning, experts said, considering the fact that smoking is a major risk factor for stroke.

And among stroke survivors, those who continue to smoke are more likely to have — or die from — a repeat stroke or a heart attack, according to lead researcher Dr. Neal Parikh. He is an assistant professor of neurology at Weill Cornell Medicine and NewYork-Presbyterian, in New York City.

Parikh said that the study results point to a need to “prioritize” smoking cessation as part of stroke recovery.

The findings are based on nearly two decades of data from an ongoing federal health survey. Among over 49,000 U.S. adults who participated between 1999 and 2016, just under 3% were stroke survivors.

Over those years, the general smoking rate declined to a statistically significant degree, according to Parikh. In contrast, there was no significant change among stroke survivors: Their smoking rate stood at 23% in 1999, and 26% by 2016.

“I think the lack of a decrease among stroke survivors speaks to the highly addictive nature of nicotine,” Parikh said.

Even when smokers are able to refrain when they are in the hospital or a rehab facility, that may not last. Once patients go home, Parikh noted, they are again surrounded by the “triggers” of their smoking habit.

Dr. Albert Rizzo, chief medical officer of the American Lung Association, also spoke to the difficulty of quitting — even after a major health scare.

“In my experience, not many patients disagree when you talk about the importance of quitting,” said Rizzo, who was not involved in the study. “They want to quit. But nicotine is addictive.”

Beyond that, recovering from a stroke can be difficult — physically, mentally and emotionally. And long-time smokers may be used to dealing with stress by lighting up, Rizzo said.

“I wish I were surprised by these findings, but I’m not,” he added. It’s a pattern that is seen in smokers with other serious ills, including lung disease.

“To me, this suggests we’re not concentrating enough on smoking cessation during stroke recovery,” Rizzo said. “We may not be offering all the services that we can.”

Parikh made the same point.

After a stroke, he said, there is a lot of emphasis on the importance of taking cardiovascular medications — blood thinners like aspirin and clopidogrel (Plavix), as well as drugs to control high blood pressure and cholesterol.

“But along with taking those prescribed medications, we need to prioritize smoking cessation,” Parikh said.

Smokers can get help with quitting in various ways, including counseling, and U.S. Food and Drug Administration-approved nicotine replacement therapy and medications. Stroke patients should talk to their doctor about all their options, Parikh said.

It’s common for people to mistakenly believe “the damage is done,” and there’s nothing to gain from quitting, he noted.

But since stroke survivors who smoke tend to fare worse, Parikh said, it’s never too late to quit.

The findings are to be presented next Wednesday at the American Stroke Association’s International Stroke Conference, in Los Angeles. Studies released at meetings are generally considered preliminary until they are published in a peer-reviewed journal.

More information

The American Lung Association has resources for smokers who want to quit.

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