Smokers with low education 'may have greater risk of stroke'

Approximately 16% of men and 11% of women are at high risk of stroke due to low education level, smoking and high blood pressure, according to a new multicenter Danish study.

The Centers for Disease Control and Prevention state by living a healthy lifestyle, which includes eating a healthy diet, maintaining a healthy weight, getting enough physical exercise, limiting alcohol use and not smoking, blood pressure can be kept within a healthy range and risk of stroke lowered.

Smokers with a lower level of education are more at risk of stroke than smokers with a higher level of education.

About 800,000 people in the US have a stroke each year, with one American dying from a stroke every 4 minutes, on average. 

Cigarette smoking is a major cause of stroke, the 4th leading cause of death in the US. Smoking almost doubles an individual's risk for stroke, though after quitting smoking, the risk of stroke decreases steadily - former smokers have the same risk of stroke as nonsmokers after 5-15 years.

Toxins in the blood from smoking cigarettes contribute to the development of atherosclerosis - a progressive hardening of the arteries caused by the deposit of fatty plaques and the scarring and thickening of the artery wall. Inflammation of the artery wall and the development of blood clots can obstruct blood flow and cause heart attacks or strokes.

Researchers divided 68,643 participants aged 30-70 years old into groups based on low, medium and high education levels and measured their smoking and high blood pressure levels. "Lower education" within the study is defined as grade school or lower secondary school, which accrues to a maximum of 10 years education.

The key findings of the study indicate:

• Approximately 16% of men and 11% of women are at high risk of stroke due to low education level, smoking and high blood pressure
• Risk of stroke increases with age, while men are more at risk of stroke than women
• During the study's 14-year follow-up, 10% of the high-risk men and 9% of the high-risk women had an ischemic stroke
• Regardless of their blood pressure, smokers with a lower level of education had a higher risk of stroke than smokers with a higher level of education.

Interventions to 'reduce smoking in lower socioeconomic groups' needed

The researchers at the Department of Public Health at the University of Copenhagen in Denmark, comment:

"We found it is worse being a current smoker with lower education than a current smoker with a higher education."

The research team highlights that targeted interventions aimed at reducing smoking and high blood pressure in lower socioeconomic groups would yield a greater reduction in stroke than targeting the same behaviors in higher socioeconomic groups. Universal interventions including legislation or taxation may have a considerable effect on stroke in the most underprivileged. Disparities in unhealthy behaviors, predominantly smoking, need to be challenged.

The distribution of stroke risk factors may vary across various contexts and study populations. However, since the most-disadvantaged groups are often exposed to a wide number of stroke risk factors, it seems plausible that these people are at higher risk of stroke not only in Denmark, but also in other industrialized countries.

The new research, published in the American Heart Association's journal Stroke, finds the combination of smoking and high blood pressure increases stroke risk the most. Researchers are unable to consider differences associated with ethnicity because 98% of the participants are Danes.

Recently, researchers reported that teen cigarette smoking has fallen to the lowest levels since the National Youth Risk Behavior Survey began in 1991. 

The results of the survey found that teen smoking is now down to 15.7%, which means the US has met the national Healthy People 2020 target of lowering high school-age smoking to 16% or less.