Smoking Status and Functional Outcomes in Young Stroke

Objective: Stroke in young adults is uncommon, and the etiologies and risk factors of stroke in young adults differ from those in older populations. Smoker's paradox is an unexpected favorable outcome, and age difference is used to explain the association between smoking and the favorable functional outcome. This study aimed to investigate the existence of this phenomenon in young stroke patients.Methods: We analyzed a total of 9,087 young stroke cases registered in the nationwide stroke registry system of Taiwan between 2006 and 2016. Smoking criteria included having a current history of smoking more than one cigarette per day for more than 6 months. After matching for sex and age, a Cox model was used to compare mortality and function outcomes between smokers and non-smokers.Results: Compared with the non-smoker group, smoking was associated with older age, higher comorbidities, and higher alcohol consumption. Patients who report smoking with National Institutes of Health Stroke Scale scores of 11–15 had a worse functional outcome (adjusted odds ratio, 0.81; 95% confidence interval, 0.76 – 0.87).Conclusion: Smokers had a higher risk of unfavorable functional outcomes at 3 months after stroke, and therefore, we continue to strongly advocate the importance of smoking cessation.

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The Misleading "Smoker's Paradox" in Young Stroke

10.21203/rs.3.rs-558246/v1 ◽

2021 ◽

Author(s):

Cheng-Loong Liang ◽

Han-Jung Chen ◽

Yi-Che Lee ◽

Cheng-Chun Wu ◽

Chon-Haw Tsai ◽

...

Keyword(s):

Smoking Cessation ◽

Young Adults ◽

Functional Outcome ◽

Cox Model ◽

Age Difference ◽

Higher Alcohol ◽

Stroke Registry ◽

Young Stroke ◽

Stroke In Young Adults ◽

Stroke In Young

Abstract Objective: Stroke in young adults is uncommon, and the etiologies and risk factors of stroke in young adults differ from those in the older populations. Smoker’s paradox is an unexpected favorable outcome, and age difference was used to explain the association between smoking and the favorable functional outcome. This study aimed to investigate the existence of this phenomenon in young stroke patients.Methods: We analyzed a total of 9,460 young stroke cases registered in the nationwide stroke registry system of Taiwan between 2006 and 2016. Smoking criteria included having a past or current history of smoking more than 1 cigarette per day for more than 6 months. After matching for sex and age, a Cox model was used to compare complications, mortality and outcomes between smokers and non-smokers.Results: Smoking was associated with older age, higher comorbidities, and higher alcohol consumption. Smoking patients with NIHSS scores of 11–15 had a worse functional outcome (adjusted OR, 0.81; 95% CI, 0.76–0.87), and smoking cessation would substantially reverse those effects.Conclusion: The smoker’s paradox definitely does not exist, and therefore we continue to strongly advocate the importance of smoking cessation.

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Post-stroke fatigue and its association with poor functional outcome after stroke in young adults

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2014-308784 ◽

2014 ◽

Vol 86 (10) ◽

pp. 1120-1126 ◽

Cited By ~ 29

Author(s):

Noortje A M M Maaijwee ◽

Renate M Arntz ◽

Loes C A Rutten-Jacobs ◽

Pauline Schaapsmeerders ◽

Henny C Schoonderwaldt ◽

...

Keyword(s):

Young Adults ◽

Functional Outcome ◽

Poor Functional Outcome ◽

Post Stroke ◽

Stroke In Young Adults ◽

Stroke In Young

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Global Outcome Assessment Life-long after stroke in young adults initiative—the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-031144 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031144

Author(s):

Merel Ekker ◽

Mina Jacob ◽

Myrna van Dongen ◽

Karoliina Aarnio ◽

Arunkar Annamalai ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Secondary Prevention ◽

Stroke Risk ◽

Individual Patient Data ◽

Meta Analysis ◽

Stroke Patients ◽

Young Stroke ◽

Stroke In Young Adults ◽

Stroke In Young

IntroductionWorldwide, 2 million patients aged 18–50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients.Methods and analysisThe Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18–50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Ethics and disseminationEthical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

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Diagnosis and outcome of cervical artery dissection

Medicinski pregled ◽

10.2298/mpns1108392d ◽

2011 ◽

Vol 64 (7-8) ◽

pp. 392-396 ◽

Cited By ~ 1

Author(s):

Ivana Divjak ◽

Petar Slankamenac ◽

Mirjana Jovicevic ◽

Tamara Rabi-Zikic ◽

Aleksandar Jesic

Keyword(s):

Young Adults ◽

Magnetic Resonance ◽

Functional Outcome ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Long Term Outcome ◽

Stroke In Young Adults ◽

Malignant Infarction ◽

Cervical Artery ◽

Stroke In Young

Introduction. Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascular disease of unknown aetiology and unclear pathogenesis that may be a cause of ischemic stroke in young adults. Diagnosis. Precise diagnosis of dissection of the cervical artery - carotid or vertebral - is possible with cervical axial magnetic resonance imaging and magnetic resonance angiography. Treatment. The recommended treatment in the acute phase of cervical artery dissection is anticoagulant or antithrombotic therapy, aimed at preventing a primary or recurrent ischemic event. There have been as yet no results of randomized controlled studies comparing efficacy of both treatments. An ongoing randomized multicentre study is expected to provide answers about the effects of these treatments in cervical artery dissection. Outcome. Complete resolution of arterial abnormalities is achieved in around 46% of stenoses, 33% of occlusions, and 12% of dissecting aneurysms. Recurrent events. Recurrence of cerebral ischemia and cervical artery dissection seems to be rare, although some data suggest that early ischemic and late cervical artery dissection recurrences could be underestimated. Mortality and functional outcome. In comparison with other causes of stroke in young adults, the functional outcome of cervical artery dissection is good in contrast to its socio-professional effects, which may be unsatisfactory. The mortality rate of cervical artery dissection is low, although it may be underestimated since some patients with malignant infarction die before the diagnosis is established. Conclusion. Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies.

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