From the Department of Public Health Sciences (G.H., L.E.W.) and the
Department of Neurology and Stroke Research Center (G.H., J.F.T.), Wake Forest
University School of Medicine, Winston-Salem, NC; Department of Biostatistics,
University of North Carolina at Chapel Hill (J.C.); National Heart, Lung, and
Blood Institute, National Institutes of Health, Bethesda, Md (L.C.); and
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (M.K.).
Correspondence to George Howard, Department of Public Health Sciences, Winston-Salem, NC 27157-1063. E-mail ghoward{at}rc.phs.wfubmc.edu
Background and Purpose—Silent
cerebral infarctions (SCIs) have a prevalence between 10% and 40% in
the transient ischemic attack population and have been
associated with increased mortality and morbidity; however, little is
known about the prevalence and risk factors for SCI in the general
population. This report focuses on the role of cigarette smoking and
other risk factors for SCI in the general population.
Methods—MRI scans were performed on 1737 participants selected
from the general population as part of the
Atherosclerosis Risk in Communities Study. Smoking
status and other major cerebrovascular risk factors were assessed, and
associations between smoking status and SCIs were established with the
use of ANCOVA.
Results—Overall, the prevalence of SCI in this population aged 55
to 70 years was 11%. Cigarette smoking had an ordered association
(P=0.029) with the presence of SCI, with the odds ratio
(OR) of nonsmoking participants exposed to environmental tobacco smoke
being 1.06 (95% confidence interval [CI], 0.64 to 1.75) times as
great as for nonsmokers not exposed; the OR of past smokers was 1.16
(95% CI, 0.74 to 1.83) times greater, and the OR of current smokers
was 1.88 (95% CI, 1.13 to 3.13) times greater. An increased prevalence
was also noted among black, older, and hypertensive participants.
Conclusions—This report is among the first to examine the risk
factors for SCI in the general population and finds a relatively high
overall prevalence (11%). There is an ordered relationship between
increasing exposure to cigarette smoke and the presence of SCI that
parallels the relationship between smoking and carotid
atherosclerosis. The magnitude of the association with
smoking is substantial compared with the effect of hypertension and
other traditional cerebrovascular risk factors. The
reduction in prevalence of SCI between current and past smokers and the
trend that increased pack-years of smoking is related to increased
prevalence of SCI are both additional arguments for smoking avoidance
and cessation.
© 1998 American Heart Association, Inc.
Original Contributions
Cigarette Smoking and Other Risk Factors for Silent Cerebral Infarction in the General Population
Key Words: cerebral ischemia • cigarette smoking • diabetes mellitus • hypertension • magnetic resonance imaging • risk factors
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