Smokers stroke risk

Hirvonen T Virtamo J, Korhonen P et al. Intake of flavonoids, carotenoids, Vitamin C and E, and risk of stroke in male smokers. Stroke 2000 3 1 2301 —2306. 

Pulmonary Does the patient require medications for pulmonary disease that may affect neurological functioning such as beta agonist-induced tremor Could a medication such as beta-blockers prescribed for essential tremor cause deterioration of pulmonary function Could an acute pulmonary illness such as pneumonia be contributing to delirium Does the patient have a history of pulmonary embolism that may indicate a predisposition to thromboembolic disorders Is the patient a current or past smoker, contributing to stroke risk or migraines ... 

Smoking- Smoking in combination with OC use has been shown to contribute substantially to the incidence of Mis in women in their mid-30s or older, with smoking accounting for the majority of excess cases. Mortality rates associated with circulatory disease have been shown to increase substantially in smokers, especially in those 35 years of age and older who use OCs. Cerebrovascular diseases - OCs increase the risks of cerebrovascular events (thrombotic and hemorrhagic strokes). In general, the risk is greatest in hypertensive women older than 35 years of age who also smoke. 

Larsson, S. C., Virtanen, M. J., Mars, M., Mannisto, S., Pietinen, R, Albanes, D., Virtamo, J. (2008). Magnesium, calcium, potassium, and sodium intakes and risk of stroke in male smokers. Arch. Intern. Med., 168,459 65. 

Smoking is especially harmful to diabetics who are already at an increased risk of cardiovascular disease, stroke, and kidney disease. The habit also negatively affects joints and interferes with the healing of wounds. Healing of fractures is delayed because smoking impairs the formation of new bone. Smokers are more likely to develop degenerative disorders and injuries of the spine. The risk for peptic ulcers is increased. Smoking also may upset thyroid function. 

Stroke is a very uncommon event in childbearing women, occurring in approximately 11 per 100,000 women over a 1-year period of time. Therefore, even a doubling of this risk with oral contraceptive pills would have minimal effect on attributable risk. The estimated risk of myocardial infarction associated with oral contraceptive pill use in nonsmokers is 3 per million women over 1 year. The estimated risk of venous thromboembolism attributable to oral contraceptive pills is less than 3 per 10,000 women per year. However, the risk may be increased in women who smoke or have other predisposing factors to thrombosis or thromboembolism. In fact, it should be emphasized that the risk of serious cardiovascular side effects is particularly marked in women over 35 years of age who are heavy smokers (e.g., more than 15 cigarettes per day). Additionally, the literature suggests that there may be an increased risk of breast cancer associated with long-term oral contraceptive pill use in women under the age of 35. However, because the incidence of breast cancer is so relatively low in this population, the attributable risk of breast cancer from birth control pill use is small. 

Patients who are addicted to nicotine in the form of cigarette smoking have one of the most common, most expensive, and most deadly addictions. Nicotine addiction is the most common cause of preventable death in the United States. Most smokers started in their teen years, and it is very hard for them to quit—possibly the hardest of all of the addictions. Patients with nicotine addiction are at a much increased risk of a long list of cancers, heart disease, and stroke, but they will definitely develop chronic lung disease if they do not die of one of the other risk factors first. 

One of the more serious concerns is the increased risk of blood clots in users of the combination pill. Blood clots can produce strokes or heart attacks, and indeed women older than 40 show an increased risk of heart attack when they take the combination pill. This risk is greatly increased if the woman is also a cigarette smoker. Mood changes, including severe depression, are often reported by women on the pill (Hyde Dcl.amater, 2006). 

Two prospective studies from Finland demonstrate that low levels of plasma lycopene, resulting from a diet low in tomatoes, significantly increase the risk for heart attack, stroke, and early atherosclerosis among middle-aged men [57, 58]. Similarly, a Dutch study revealed a lowered risk for aortic calcification in current and former smokers with higher lycopene plasma concentrations [59]. Finally, results from a European multicenter case control study (EURAMIC) are suggestive of a protective effect of lycopene against myocardial infarction [60]. 

Fibrinogen has also been implicated in atherogenesis and thrombus formation, and has been found to be elevated in smokers (34,35). The Framingham Study has shown that risk of cardiovascular disease (C VD) and stroke increased with increases in fibrinogen levels. In this study, as well as in other studies, smokers had a higher risk of developing claudication compared with nonsmokers with similar risk factor profiles (17,36-40). 

Passive smoking (also known as secondhand smoke, or ETS) has been shown to produce the same health effects on those exposed to it as to actual smokers, albeit to a lesser degree [46, 47]. ETS is responsible for approximately 3(XK) lung cancer deaths in the United States annually [48], increases the risk of stroke [49], risk of myocardial infarction and other cardiovascular diseases [50, 51], and impacts respiratory health in those exposed [52]. The cardiovascular effect of secondhand tobacco smoke is illustrated by the drastic reduction of acute myocardial infarctions (heart attacks) noted in Helena, Montana when public smoking was banned [53]. This is discussed more thoroughly in Section 29.4. 

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