Background: Smoking is one of the most common preventable risk factor for cerebrovascular diseases. This study was designed to evaluate the associations between a history of cigarette smoking and stroke short and long-term stroke outcomes.
Methods: Patients were recruited from the Mashhad Stroke Incidence Study. This is is a population-based stroke study ascertained all cases of stroke among individuals living in 3 neighborhoods of Mashhad (n=450,229), Iran. Patients were followed up longitudinally for five years. Disability and functional dependency were measured using the modified Rankin scale (mRS>2). We used multivariable logistic and Cox regression models to assess the effect of smoking on short- and long-term stroke outcomes including disability and mortality.
Results: 624 patients with first-ever strokes (mean age 64.6 ±14.8) were recruited during the study period,including 80(12.8%) patients with intracerebral hemorrhage and 512(82.1%) patients with ischemic strokes. 98 patients (M/F:48/48) had a history of smoking before the index stroke. Smoking was associated with disability at three-month and one-year follow-up after stroke (odds ratio [OR](95%CI):1.91(1.04-3.51) and 2.26(1.15-4.45), p<0.05, respectively). Moreover, smoking was associated with one-year post-stroke disability in ischemic stroke patients(OR(95%CI)=2.25(1.10-4.65), p=0.03). After adjustment for socioeconomic and vascular risk factors a history of smoking was associated with the severity of stroke (measured by the NIHSS) at the time of admission (beta(95%CI)=2.71(2.54-2.98)), 3 months (beta(95%CI)= 0.66(0.37-0.96)), 1 year (beta(95%CI)= 0.88(0.59-1.18)) and 5 years after the stroke(beta(95%CI)1.87(1.42-2.33)), p<0.001). After adjustment for vascular risk factors, a smoking was not a determinant of short and long-term mortality.
Conclusion: Public should be aware of the association between smoking and stroke.

Pre-Stroke Cigarette Smoking Are Associated with Stroke Severity and Post-Stroke Disability