Published online before print March 27, 2003, doi: 10.1161/01.STR.0000065200.93070.32
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(Stroke. 2003;34:1151.)
© 2003 American Heart Association, Inc.
Original Contributions |
Smoking and the Risk of Hemorrhagic Stroke in Men
From Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital (T.K., K.B., E.S.S., J.E.B., J.M.G), and Department of Ambulatory Care and Prevention (J.E.B.), Harvard Medical School, Boston Mass; Department of Epidemiology, Harvard School of Public Health, Boston, Mass (T.K., J.E.B.); Department of Neurology, Boston University Medical Center, Boston, Mass (C.S.K.); Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany (K.B.); Department of Nephrology, University of Freiburg, Freiburg, Germany (E.S.S.); and Massachusetts Veterans Epidemiology Research and Information Center, Boston VA Healthcare System, Boston Mass (J.M.G.).
Correspondence to Tobias Kurth, MD, MSc, Brigham and Women’s Hospital, Division of Preventive Medicine, 900 Commonwealth Ave E, Boston, MA 02215-1204. E-mail tkurth{at}rics.bwh.harvard.edu
Background and Purpose— Smoking is an established risk factor for ischemic stroke and subarachnoid hemorrhage (SAH), but the impact of smoking on intracerebral hemorrhage (ICH) is less clear.
Methods— Prospective cohort study among 22 022 US male physicians participating in the Physicians’ Health Study. Incidence of stroke was measured by self-report and confirmed by medical record review. We used Cox proportional-hazards models to evaluate the association of smoking with risk of total hemorrhagic stroke, ICH, and SAH. We categorized smoking into 4 groups: never, past, or current smokers of <20 or of 
20 cigarettes per day.
Results— During 17.8 years of follow-up, 108 ICHs and 31 SAHs occurred. Never smokers and past smokers had equal rates of ICH and SAH. Current smokers of <20 cigarettes per day had multivariable-adjusted relative risks of 1.65 (95% CI, 0.61 to 4.50) for total hemorrhagic stroke, 1.60 (95% CI, 0.50 to 5.07) for ICH, and 1.75 (95% CI, 0.24 to 13.09) for SAH when compared with never smokers. Current smokers of 20 cigarettes had relative risks of 2.36 (95% CI, 1.38 to 4.02) for total hemorrhagic stroke, 2.06 (95% CI, 1.08 to 3.96) for ICH, and 3.22 (95% CI, 1.26 to 8.18) for SAH when compared with never smokers.
Conclusions— This prospective study suggests an increased risk of total hemorrhagic stroke, ICH, and SAH in current cigarette smokers with a graded increase in risk that depended on how many cigarettes were smoked. The effect of smoking on ICH is of about the same magnitude as the effect of smoking on ischemic stroke. Our results add to the multiple health benefits that can be accrued by abstaining from cigarette smoking.
Key Words: cigarette smoking • cohort study • intracerebral hemorrhage • risk factors • subarachnoid hemorrhage
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