TY - JOUR
T1 - Smoking as a risk factor for stroke in women compared with men
T2 - A systematic review and meta-analysis of 81 cohorts, including 3 980 359 individuals and 42 401 strokes
AU - Peters, Sanne A.E.
AU - Huxley, Rachel R.
AU - Woodward, Mark
PY - 2013/10/1
Y1 - 2013/10/1
N2 - Background and Purpose-It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men. Methods-PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled. Results-Data from 81 prospective cohort studies that included 3 980 359 individuals and 42 401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99-1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02-1.18)] but not in Asian (RRR, 0.97 [0.87-1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99-1.22]). Conclusions-Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.
AB - Background and Purpose-It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men. Methods-PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled. Results-Data from 81 prospective cohort studies that included 3 980 359 individuals and 42 401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99-1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02-1.18)] but not in Asian (RRR, 0.97 [0.87-1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99-1.22]). Conclusions-Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.
KW - Meta-analysis
KW - Risk factors
KW - Sex differences
KW - Smoking
KW - Stroke
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U2 - 10.1161/STROKEAHA.113.002342
DO - 10.1161/STROKEAHA.113.002342
M3 - Article
C2 - 23970792
AN - SCOPUS:84888327094
SN - 0039-2499
VL - 44
SP - 2821
EP - 2828
JO - Stroke
JF - Stroke
IS - 10
ER -