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(Stroke. 2008;39:1694.)
© 2008 American Heart Association, Inc.

Original Contributions

Cigarette Smoking, Systolic Blood Pressure, and Cardiovascular Diseases in the Asia-Pacific Region

Koshi Nakamura, MD; Federica Barzi, PhD; Tai-Hing Lam, MD; Rachel Huxley, DPhil; Valery L. Feigin, MD; Hirotsugu Ueshima, MD; Jean Woo, MD; Dongfeng Gu, MD; Takayoshi Ohkubo, MD; Carlene M.M. Lawes, PhD; Il Suh, MD; Mark Woodward, PhD for the Asia Pacific Cohort Studies Collaboration

From the Nutrition and Lifestyle Division (K.N., F.B., R.H.), The George Institute for International Health, Sydney, Australia; Department of Community Medicine (T.H.L.), University of Hong Kong, People’s Republic of China; Clinical Trials Research Unit (V.L.F., C.M.M.L.), University of Auckland, New Zealand; Department of Health Science (H.U.), Shiga University of Medical Science, Otsu, Japan; Division of Geriatrics (J.W.), Department of Medicine & Therapeutics, Chinese University of Hong Kong, People’s Republic of China; Cardiovascular Institute and Fu Wai Hospital (D.G.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; Department of Planning for Drug Development and Clinical Evaluation (T.O.), Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan; Department of Preventive Medicine (I.S.), Yonsei University College of Medicine, Seoul, Korea; Mount Sinai Medical Center (M.W.), New York.

Correspondence to Koshi Nakamura, MD, Nutrition and Lifestyle Division, The George Institute for International Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia. E-mail knakamura{at}george.org.au

Background and Purpose— Smoking and increased levels of blood pressure (BP) substantially increase the risk of cardiovascular diseases (CVD). If these 2 risk factors have a synergistic impact on cardiovascular events, lowering BP and quitting smoking will contribute more to reducing CVD than would be expected from ignoring their interaction.

Methods— Individual participant data were combined from 41 cohorts, involving 563 144 participants (82% Asian). During a median of 6.8 years follow-up, 4344 coronary heart disease (CHD) and 5906 stroke events were recorded. Repeat measures of systolic blood pressure (SBP) were used to adjust for regression dilution bias. Hazard ratios (HRs) and 95% confidence intervals (CIs) for SBP by cigarette smoking status were estimated from Cox proportional hazard models adjusted for age and stratified by study and sex.

Results— Data suggested a log-linear relationship between SBP and all subtypes of CVD. The HRs relating SBP to both CHD and ischemic stroke were broadly similar irrespective of smoking status (P0.1). For hemorrhagic stroke (intracerebral hemorrhage), the HRs (95% CIs) for an additional 10 mm Hg increment in SBP were 1.81 (1.73 to 1.90) for present smokers and 1.66 (1.59 to 1.73) for nonsmokers (P=0.003). For every subtype of cardiovascular events, similar results were found for analyses involving only fatal events.

Conclusions— Smoking exacerbated the impact of SBP on the risk of hemorrhagic stroke. Although quitting smoking and lowering BP are both crucial for prevention of CVD, combining the 2 could be expected to have extra beneficial effect on preventing hemorrhagic stroke.

Key Words: smoking • blood pressure • cardiovascular diseases • coronary heart disease • stroke