Dr Melissa Walton-Shirley


August 28, 2012

If you have a patient, friend, significant other, or family member who is still smoking after a recent stroke, stop what you're doing, attach this in an email, and hit send. Better yet: text/instant message/call, because smoking poststroke is like standing on the edge of a cliff, wind gusting at 70 miles per hour, the foothold slick and muddy. Dr Furio Colivicchi, from Rome, presented the "Smoking increases death risk by threefold" study today at this morning's ESC 2012 Congress in Munich, but the title wasn't the half of it.

Unfortunately, 50% of stroke patients in this trial who claimed to be motivated to quit at the time of discharge relapsed in three weeks. If a patient resumed smoking within 10 days of discharge, their risk of death in the following year was five times greater than those who managed to abstain. Although these stats are both staggering and frightening, they don't seem to have much impact on the way our patients are behaving. Perhaps we need to put the information in terms that our patients can relate to.

The risk of dying if one continues to smoke is so frighteningly real it triggers the question: "Why on earth don't they just quit?" Perhaps we can help if we place that risk in context of things human beings fear most. To drive the point home, I "borrowed" a few stats from the LiveScience website piece entitled "The odds of dying" written by Roy Britt in 2005. Other than the growing fixation with the risk of earth's colliding with an asteroid, fueled by recent theater fair like the movie Looking for a friend at the end of the world, not much has changed over the past several years. Here is how the risk of smoking poststroke stacks up with other mechanisms of our demise:


Risk of death (%)

Smoking poststroke


Accidental injury








Airline crash






Asteroid collision


I don't think we can belabor emphasizing the high risk of death in a poststroke smoker too much. Good and caring people would do anything within reason to assist a person at risk. Recommend they seek help, get counseling, speak to their physicians about smoking cessation aids, and keep trying no matter how long it takes. It's easy to start now. Attach this and hit send. To borrow a phrase from Nike: Just do it!


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