Division of Cardiology, Department of Internal Medicine Hallym University Dongtan Sacred Heart Hospital Hwaseong Korea.
Department of Statistics and Actuarial Science Soongsil University Seoul Korea.
J Am Heart Assoc. 2024 Jun 4;13(11):e034779. doi: 10.1161/JAHA.124.034779. Epub 2024 May 28.
Survivors of stroke, particularly the older population, are at an increased risk of falls and incident fractures. Smoking is a widely recognized risk factor for fractures. However, the association between changes in smoking habits before and after an index stroke and increased risk of fracture remains unelucidated.
Using the Korean National Health Insurance program, patients with ischemic stroke between 2010 and 2016 were enrolled. Individuals were classified by smoking habits: "never smoker," "former smoker," "smoking quitter," "new smoker," and "sustained smoker." The primary outcome was the composite outcome of the vertebral, hip, and any fractures. Multivariable Cox proportional hazards regression analysis was conducted, using the never-smoker group as the reference. Among 177 787 patients with health screening data within 2 years before and after ischemic stroke, 14 991 (8.43%) patients had any fractures. After multivariable adjustment, the sustained smokers had a significantly increased risk of composite primary outcomes of any, vertebral, and hip fractures (adjusted HR [aHR], 1.222 [95% CI, 1.124-1.329]; aHR, 1.27 [95% CI, 1.13-1.428]; aHR, 1.502 [95% CI, 1.218-1.853], respectively). Additionally, the new smoker group exhibited a similar or higher risk of any fractures and hip fractures (aHR, 1.218 [95% CI, 1.062-1.397]; aHR, 1.772 [95% CI, 1.291-2.431], respectively).
Sustained smokers had a significantly increased risk of vertebral and hip fractures after an ischemic stroke. The risk of any hip fractures was higher in new smokers after ischemic stroke. As poststroke fractures are detrimental to the rehabilitation process of patients with stroke, physicians should actively advise patients to stop smoking.
中风幸存者，尤其是老年人群，发生跌倒和骨折事件的风险增加。吸烟是骨折的公认危险因素。然而，在索引性中风前后吸烟习惯的变化与骨折风险增加之间的关系仍未阐明。
利用韩国国家健康保险计划，纳入了 2010 年至 2016 年间患有缺血性中风的患者。根据吸烟习惯将患者分为以下几类：“从不吸烟者”、“曾经吸烟者”、“戒烟者”、“新吸烟者”和“持续吸烟者”。主要结果是椎体、髋部和任何部位骨折的复合结果。使用从不吸烟者组作为参考，对多变量 Cox 比例风险回归分析进行了分析。在 177787 例缺血性中风前 2 年和后 2 年内有健康筛查数据的患者中，有 14991 例（8.43%）患者发生了任何部位的骨折。在多变量调整后，持续吸烟者发生任何、椎体和髋部骨折的复合主要结局的风险显著增加（调整后的 HR [aHR]，1.222 [95%CI，1.124-1.329]；aHR，1.27 [95%CI，1.13-1.428]；aHR，1.502 [95%CI，1.218-1.853]）。此外，新吸烟者组发生任何部位骨折和髋部骨折的风险相似或更高（aHR，1.218 [95%CI，1.062-1.397]；aHR，1.772 [95%CI，1.291-2.431]）。
缺血性中风后，持续吸烟者发生椎体和髋部骨折的风险显著增加。缺血性中风后，新吸烟者发生任何髋部骨折的风险更高。由于中风后骨折对中风患者的康复过程不利，医生应积极建议患者戒烟。
