Cheon Dae Young, Han Kyung-Do, Ye Dong A, Lee Yeon Jung, Lee Jeen Hwa, Choi Jae Hyuk, Lee Sook Jin, Han Seongwoo, Park Myung Soo, Lee Minwoo
Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea,
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Neuroepidemiology. 2025;59(2):160-168. doi: 10.1159/000540058. Epub 2024 Jun 27.
Smoking is a well-known risk factor for cardiovascular diseases, including myocardial infarction (MI) and ischemic stroke (IS). While the relationship between smoking and the risk of cardiovascular diseases is established, the impact of changing smoking habits post-IS on the risk of subsequent MI remains unclear. This study aims to elucidate the effects of alterations in smoking behavior following an IS diagnosis on the likelihood of experiencing an MI.
Utilizing data from the Korean National Health Insurance Services Database, this nationwide population-based cohort study included 199,051 participants diagnosed with IS between January 2010 and December 2016. Smoking status was categorized based on changes in smoking habits before and after IS diagnosis. The association between changes in smoking behavior and the risk of subsequent MI was analyzed using multivariable Cox proportional hazard regression models.
During a median follow-up of 4.17 person-years, a total of 5,734 (2.88%) patients were diagnosed with MI after IS. Smoking quitters (2.93%) or former smokers (2.47%) have a similar or lower rate of MI than the average, even if they have smoked cigarettes, while sustained smokers (3.46%) or new smokers (3.81%) have much higher rates of MI. Among sustained and new smokers, the risk of incident MI was significantly higher than never smokers (new smoker adjusted HR [aHR]: 1.496, 95% CI: 1.262-1.774; sustained smoker aHR: 1.494, 95% CI: 1.361-1.641). Also, among the study participants, approximately two-thirds continued smoking after their IS diagnosis.
Changing smoking habits after an IS diagnosis significantly influences the risk of subsequent MI. Specifically, continuing or starting to smoke after an IS diagnosis is associated with a higher risk of MI. These results underscore the importance of targeted smoking cessation interventions for stroke patients to reduce the risk of subsequent MI.
吸烟是包括心肌梗死（MI）和缺血性中风（IS）在内的心血管疾病的一个众所周知的危险因素。虽然吸烟与心血管疾病风险之间的关系已被确立，但IS后吸烟习惯的改变对随后发生MI的风险的影响仍不清楚。本研究旨在阐明IS诊断后吸烟行为的改变对发生MI可能性的影响。
利用韩国国民健康保险服务数据库的数据，这项基于全国人群的队列研究纳入了2010年1月至2016年12月期间诊断为IS的199,051名参与者。吸烟状况根据IS诊断前后吸烟习惯的变化进行分类。使用多变量Cox比例风险回归模型分析吸烟行为变化与随后发生MI的风险之间的关联。
在中位随访4.17人年期间，共有5,734名（2.88%）患者在IS后被诊断为MI。戒烟者（2.93%）或既往吸烟者（2.47%）发生MI的比率与平均水平相似或更低，即使他们曾经吸烟，而持续吸烟者（3.46%）或新吸烟者（3.81%）发生MI的比率要高得多。在持续吸烟者和新吸烟者中，发生MI的风险显著高于从不吸烟者（新吸烟者调整后风险比[aHR]：1.496，95%置信区间：1.262 - 1.774；持续吸烟者aHR：1.494，95%置信区间：1.361 - 1.641）。此外，在研究参与者中，约三分之二在IS诊断后继续吸烟。
IS诊断后改变吸烟习惯会显著影响随后发生MI的风险。具体而言，IS诊断后继续吸烟或开始吸烟与发生MI的较高风险相关。这些结果强调了针对中风患者进行有针对性的戒烟干预以降低随后发生MI风险的重要性。
