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From the Stoke Unit, The Neurological Institute,
Columbia–Presbyterian Medical Center, New York, NY (H.M., J.L.P.T.,
A.H., J.P.M., R.L.S.); the Stroke Unit, Neurologische Klinik,
Universitätsklinikum Benjamin Franklin, Freie Universität Berlin,
Berlin, Germany (H.M., C.H., P.M.); and the Department of Public Health
(Epidemiology) in the Sergievsky Center, Columbia University, College of
Physicians and Surgeons, New York, NY (R.L.S.).
Correspondence to H. Mast, MD, Stroke Unit, The Neurological Institute, 710 W 168th St, New York, NY, 10032. E-mail ah267{at}columbia.edu
Background and Purpose—We sought to
investigate the association of cigarette smoking with high-grade
carotid artery stenosis in Hispanic, black, and white patients
with cerebral ischemia in two independent samples.
Methods—Prospectively collected data from the Northern Manhattan
Stroke Study (NOMASS) (n=431) and the Berlin Cerebral Ischemia
Databank (BCID) (n=483) were used separately for a cross-sectional
study estimating the association between cigarette smoking and
high-grade carotid stenosis (defined as a luminal narrowing of
Results—High-grade carotid stenoses were found in 14% of
the NOMASS and in 21% of the Berlin patients. In Berlin the entire
sample was white, whereas in New York only 19% of the cohort were
white. In both samples, smoking was independently associated with
severe carotid stenosis (NOMASS: odds ratio [OR], 1.5; 95%
confidence interval [CI], 1.1 to 2.0; BCID: OR, 3.9; 95% CI, 2.4 to
6.4). Patients smoking 20 pack-years or more showed a significant
association (OR, 2.0; 95% CI, 1.1 to 3.9), whereas no significant
effect was found for lower amounts of cigarette use. In NOMASS, white
smokers displayed a significant (OR, 3.2; 95% CI, 1.1 to 8.9)
association with high-grade carotid stenosis, the association
for black smokers was less strong, and no association was found among
Hispanics.
Conclusions—Smoking is an independent determinant of severe
carotid artery stenosis in patients with focal cerebral
ischemia. The association differs by race/ethnicity, with the
greatest effect observed among whites.
© 1998 American Heart Association, Inc.
Original Contributions
Cigarette Smoking as a Determinant of High-Grade Carotid Artery Stenosis in Hispanic, Black, and White Patients With Stroke or Transient Ischemic Attack
60%, diagnosed by duplex and/or Doppler ultrasound). In both
studies, cerebral ischemia patients with normal sonographic
findings or nonstenosing plaques of their carotid arteries served as a
comparison group. Multivariate logistic regression
models were used for statistical tests to determine the association
between smoking and the dependent variable for high-grade carotid
stenosis. Age, sex, hypertension, diabetes,
hypercholesterolemia, and race/ethnicity were
considered potential confounders. Further analyses of the
NOMASS data estimated the effect of the amount of cigarette use and the
impact of race/ethnicity.
Key Words: carotid stenosis • cigarette smoking • stroke
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