Abstract Details

Title Risk and Predictors of Relapse after Smoking Cessation in Patients with Ischemic Stroke and Transient Ischemic Attack

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 089

Objective To determine the rate and predictors of smoking relapse after stroke and TIA.

Background Smoking cessation is important in secondary stroke prevention. Relapse after successful smoking cessation in this population is poorly understood.

Design/Methods This is a retrospective cohort analysis of participants in the international Insulin Resistance Intervention After Stroke (IRIS) trial, which included 3,876 patients with ischemic stroke or TIA. In IRIS, patients were asked about smoking status at the time of stroke/TIA, at randomization, and annually thereafter for 5 years. For this analysis, we included patients who quit smoking by randomization. Patients with active smoking at any follow-up visit were categorized as relapsed. Cumulative relapse rates were estimated with time-to-event analysis. We used univariate Cox proportional hazards regression to assess possible predictors of relapse: demographics, index event type (stroke vs TIA), country, cardiovascular comorbidities, and duration/intensity of smoking.

Results At the time of stroke/TIA, 1,072 patients were active smokers. By randomization, a median of 3 (IQR, 2-5) months later, 450 (42%) had quit smoking. The mean age of the 450 quitters was 58 years, and 35% were women. They had smoked a median of 20 (IQR, 10-25) cigarettes/day for a median of 40 (IQR, 34-46) years. Over a mean follow-up of 3.8 years, 156 patients relapsed. The 5-year cumulative relapse rate was 38% (95% CI, 34-43%), with 21% (95% CI, 18-25%) relapsing within 1 year. Age, sex, index event type, duration/intensity of smoking were not associated with relapse. However, patients at US sites (vs non-US sites) were more likely to relapse (HR, 1.46; 95% CI, 1.01-2.10), as were patients with more cardiovascular comorbidities (HR, 1.28; 95% CI, 1.05-1.55; for each additional condition).

Conclusions Stroke/TIA survivors with early smoking cessation have a high rate of relapse, highlighting a need for sustained smoking-cessation interventions.

Authors/Disclosures
Neal S. Parikh, MD (Alnylam Pharmaceuticals) PRESENTER	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has or had stock in Alnylam Pharmaceuticals.
	No disclosure on file
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MindRhythm Inc. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for multiple medicolegal firms.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.

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