More than a third of smokers continue to use nicotine after a subarachnoid haemorrhage (SAH) stroke and need to be targeted in smoking cessation programmes, according to US research.

A team from New York looked at 620 SAH patients treated between July 1996 and November 2002, and evaluated continued cigarette use in 152 patients who were alive at three months. They discovered that 37 per cent resumed smoking after their stroke and they were more likely to be younger than their peers who quit the habit. They were also more likely to be black, to have begun smoking at an earlier age and have a higher frequency of prior alcohol or cocaine use and self-reported depression. The authors report that one of the dangers of returning to smoking is that tobacco use is a risk factor for the formation of multiple and larger aneurysms. This may therefore be a risk factor for recurrent SAH after aneurysm repair, they warn. And, although the authors say that no study has estimated the risk of recurrent SAH, if individuals continue to smoke, several lines of evidence suggest that continued smoking might increase this risk. As a consequence, the team, from the Columbia University College of Physicians and Surgeons, explain that they have developed a strategy to treat all smokers with a transdermal nicotine patch in the hospital and following discharge. “Identification of risk factors for continued cigarette use after SAH may allow more effective substance-use interventions while patients are in the hospital and may ultimately decrease the risk of recurrent SAH and other cardiovascular events,” say the study’s authors. “There is a need to develop improved psychosocial and medical treatment interventions targeted at smoking cessation after SAH, which should be routinely offered as part of the rehabilitation and ongoing care of these patients.”

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