Researchers recently reviewed more than a decade of data from the Jackson Heart Study (JHS), the largest U.S. study focused on environmental and genetic risk factors associated with cardiovascular disease among African Americans, to assess the relationship between cigarette smoking and risk of stroke specifically among African Americans. What they found emphasizes the real impact cigarettes have on health, and shed light on health disparities that also spike a person’s risk for cardiovascular disease (CVD). The new study, published June 10, 2020, in the Journal of the American Heart Association, followed nearly 4,500 African Americans in the Jackson, Mississippi area for an average of 12 years. The researchers found that a person’s stroke risk increased with the number of cigarettes they smoked in a day. According to the study, African Americans who smoke cigarettes are twice as likely to have a stroke as nonsmokers, while those who smoked more than a pack a day — 20 or more cigarettes — had a threefold increase in stroke risk. Smokers were also more likely to have carotid atherosclerosis (CIMT) — plaque buildup in the arteries which can cause an ischemic stroke — and the risk increased with the number of cigarettes a person regularly smoked. The study also found that the risk of stroke was the same for past smokers who had quit and those who never smoked at all, despite past smokers having higher rates of hypertension and diabetes, two of the leading risk factors for stroke. “This finding gives doctors fuel when encouraging people to change their habits,” says Willie E. Lawrence Jr., MD, chief of cardiology at the Midwest Heart and Vascular Specialists in Kansas City, Missouri, who was not involved with the study. “What this is saying is that at some point, once you quit smoking, your risk of developing stroke is no greater than if you had never been a smoker.” Adebamike Oshunbade, MD, MPH, a postdoctoral research fellow in the division of cardiology at the University of Mississippi Medical Center in Jackson, who authored the new study, says that while there is extensive research documenting the link between cigarette smoking and stroke, very little of it has focused on African Americans, a community that is already at a higher risk for stroke. According to U.S. Department of Health and Human Services Office of Minority Health data, African Americans are 50 percent more likely than white Americans to have a stroke. In addition, black women in the United States are twice as likely to have a stroke than white women and black men are 60 percent more likely to die of stroke than white men, the national statistics show. “We have a lot of information about stroke risk in white populations, but very little on those who are actually more affected by stroke,” says Dr. Oshunbade. “We wanted to study the relationship in this vulnerable population, especially because a lot of cigarette companies target African Americans.” A study published in July 2018, in the journal Health and Place, found that ads for menthol cigarettes were more prevalent in stores located in predominantly African American neighborhoods. The new study found that African Americans who were current smokers were usually young and the U.S. Food and Drug Administration (FDA) recognizes that menthol cigarettes are both popular among young smokers and may be harder to quit than cigarettes without the flavoring.
Highlighting Widespread Health Inequalities
In addition to providing additional data that links cigarette smoking to a higher risk of stroke, Dr. Lawrence says the new study also sheds light on the nation’s broader racial health disparities, including factors other than smoking that contribute to a higher risk of stroke among African Americans. “This study shows that there are not great differences across race as it relates to how much smoking increases a person’s risk of stroke. Most of the increased risk will not be explained by genetics, but by things in our environment — there are factors directly related to health, such as access to healthcare, but also factors related to economics and whether you live in a community where you can safely exercise and have access to healthy food," says Lawrence. “It’s a discussion of health equity and the factors that determine health, including social circumstances, healthy lifestyle behaviors, genetics and access to healthcare.” According to Oshunbade, not smoking is a modifiable risk factor that people have control over, despite the health disparities that put them at higher risk for stroke. “The more people smoke, the greater their risk for stroke, regardless of other risk factors including education or sex, and it’s especially important for people in vulnerable populations to know this risk,” he says.
