- Clarify that a small Spanish study found that smokers admitted to hospital for an acute stroke were more likely to have successfully quit smoking at one year if they had a preadmission intention to stop smoking in the near future or if they had a stroke affecting the insular cortex.
- Note that only about one-third of patients associated smoking with an increased risk of stroke.
The only other factor associated with the likelihood of remaining abstinent at one year was a lesion affecting the insular cortex, which is key to the maintenance of tobacco addiction (OR 5.42, 95% CI 1.95 to 15.01).
“The results should make it possible to conduct antismoking and health education sessions with patients with stroke with a more precise understanding of the process of giving up smoking with regard to the factors that predispose and determine cessation,” Suñer and colleagues wrote.
For one year, the researchers followed 110 smokers admitted to the Josep Trueta University Hospital of Girona for an acute stroke (89.1% ischemic). At the time of the stroke, the patients were smoking an average of 27.6 cigarettes per day.
CT scans or MRIs performed at admission and at an average of five days after stroke onset revealed that about one-quarter of the patients (24.5%) had a lesion that damaged the insular cortex.
At admission, most of the patients (85.5%) said that they were not considering stopping smoking in the near future when they had the stroke. about one-third saw an association between smoking and stroke, with an equal proportion perceiving no such association. the rest said they did not know.
“This fact is indicative of the lack of awareness regarding stroke risk factors in the general population and highlights the need to improve the information given so as to make progress in the primary prevention of this disease,” the authors wrote.
Throughout the year-long follow-up, patients who had an acute stroke lesion in the insular cortex were more likely to maintain abstinence than other patients. At one year, for example, 70.3% with an insular cortex lesion were not smoking, compared with 30.1% of the other patients (P<0.001).
Patients with an insular cortex lesion reported less difficulty in giving up smoking (P<0.05).
In a multivariate analysis, the two factors associated with quitting by one year after the stroke were the presence of an insular cortex lesion and a pre-stroke intention to quit in the near future (P≤0.004 for both).
The authors noted some limitations of the study, including the relatively small sample size; the difficulty of following the patients; the exclusion of severely ill patients and those who could not be followed up; and the lack of an evaluation of the impact of the home environment on successful smoking cessation.
The authors reported that they had no conflicts of interest.