Smoking predicts long-term mortality in stroke: The European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study

BACKGROUND.: While the relationship between risk factors and stroke is well established, there is less information about the risk factors and survival after stroke. We examined the independent association between cardiovascular and modifiable lifestyle risk factors and subsequent mortality in people with stroke. METHODS.: 308 free-living men and women with stroke at baseline survey in 1993-1997 participating in the European Prospective Investigation into Cancer (EPIC)-Norfolk were followed up for long-term mortality (average follow-up 7.5 years). Using Cox's proportional hazards model, we assessed the relationships between an individual's age, sex, cardiovascular risk profile including systolic blood pressure, body mass index, cholesterol, history of diabetes and lifestyle behaviors smoking and alcohol consumption and subsequent mortality up to July 2004. RESULTS.: There were a total of 100 deaths during follow-up (total person years = 2318). Advancing age (RR 1.72, 95%CI: 1.42, 2.09) and current smoking (RR 2.27, 95%CI: 1.12, 4.57) predicted higher risk while female sex was associated with reduced risk (RR 0.51, 95%CI; 0.31, 0.84) of subsequent mortality after stroke independently of other risk factors investigated. CONCLUSIONS.: Our findings may provide further empirical encouragement for smoking cessation after stroke.