A SIGNIFICANT association between smoking and the occurrence of cryptogenic ischemic strokes (CIS) in young adults has been published in a new study. The study emphasizes the heightened risk among male smokers and those with a history exceeding 20 pack-years.
The SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome) study conducted a multicenter case-control analysis across 19 European stroke centers. Researchers prospectively recruited 546 patients aged 18–49 years who experienced a first-ever CIS within two weeks of symptom onset. Each patient was matched with a stroke-free control of the same sex and similar age (±5 years). Data collection encompassed tobacco use, intensity of smoking, socioeconomic status, and comorbidities, utilizing a standardized questionnaire. The analysis employed conditional logistic regression, adjusting for low education status and vascular risk factors, to assess the association between smoking and CIS.
Findings revealed that 32.8% of CIS patients were smokers, compared to 14.8% of controls, indicating a significant difference (p ≤ 0.001). After adjustments, smoking was associated with a 2.39-fold increase in the odds of experiencing CIS (95% CI 1.65–3.47). The association was notably stronger in men, with an odds ratio of 3.34 (95% CI 1.91–5.84), and was most pronounced in the 45–49-year age group, presenting an odds ratio of 3.77 (95% CI 1.74–8.17).
The study also examined the impact of smoking intensity, measured in pack-years. Individuals with over 20 pack-years exhibited a 4.30-fold increase in CIS risk (95% CI 2.10–8.81). This risk escalated further among men (OR 6.97; 95% CI 2.58–18.82) and within the 45–49-year age bracket (OR 4.91; 95% CI 1.74–13.85).
Beyond smoking, other factors such as low education status (55.6% in patients vs. 35.2% in controls, p ≤ 0.001), hypertension (34.7% vs. 26.8%, p ≤ 0.005), obesity (59.3% vs. 44.4%, p ≤ 0.001), physical inactivity (29.4% vs. 23.6%, p ≤ 0.02), and heavy alcohol use (13.7% vs. 6.7%, p ≤ 0.001) were more prevalent among CIS patients.
The researchers concluded that both smoking and high-intensity smoking are associated with an increased risk of CIS in young adults, particularly among men and those aged 45–49 years. These findings underscore the critical need for targeted smoking cessation programs and preventive strategies to mitigate stroke risk in this demographic.
Reference: Ferdinand P et al. Association of Smoking and Young Cryptogenic Ischemic Stroke: A Case-Control Study. Neurol Open Access. 2025;1(1).
Anaya Malik | AMJ
