Relapse After Smoking Cessation is High Among Stroke, TIA Survivors: New Findings

The 5-year cumulative relapse rate among early quitters was nearly 40% in a large international cohort of stroke patients, according to an abstract presented at ISC22.

The relapse rate after early smoking cessation among survivors of stroke and TIA is high, according to a new study that found a 5-year cumulative relapse rate of 38%.

The study, presented this week at the 2022 International Stroke Conference, also found that relapse was more likely among patients with more cardiovascular conditions. The findings suggest a need for more intensive cessation interventions in this vulnerable population, according to study authors.

As context for their research, investigators from Weill Cornell Medicine, led by Neal Parikh, MD, MS, assistant professor of Neurology, note that while smoking cessation interventions are integral to secondary prevention after stroke and TIA, there is little research available on the rate of relapse after successful quitting.

Parikh et al conducted a retrospective cohort analysis of patients enrolled in the international Insulin Resistance Intervention After Stroke (IRIS) trial, a population of 3876 patients without diabetes who had experienced ischemic stroke or TIA.

Background information in IRIS included smoking status at the time of the index event, at randomization, and then annually for 5 years. The current analysis included patients who had stopped smoking at the time of randomization. Relapse was defined as active smoking at any follow-up visit. Cumulative relapse rates were estimated using time-to-event analysis and possible predictors of relapse were assessed by univariate Cox proportional hazards. The possible predictors analyzed were demographics, index event type (stroke vs TIA), country of origin, cardiovascular comorbidities, and duration/intensity of smoking, according to the study abstract.


At the time of stroke/TIA, 1072 patients identified themselves as active smokers. Of those, by the time of randomization, a median of 3 months later, 450 (42%) had quit smoking. Quitters had a mean age of 58 years, and 35% were women. Smoking history was a median of 20 cigarettes/day for a median of 40 years. During a median follow-up period of 3.8 years, 156 patients began smoking again.

The 5-year cumulative relapse rate, based on time to event analysis, was 38% (95% CI, 34-43%), with 21% (95% CI, 18-25%) relapsing within 1 year, according to the study.

Among the possible predictors of relapse evaluated, investigators observed no association between age, sex, index event type, or duration and intensity of smoking and relapse. The analyses did find, however, that relapse was more likely (HR, 1.46; 95% CI, 1.01-2.10) among patients at US sites vs non-US sites in the IRIS trial, and among patients with more cardiovascular comorbidities (HR, 1.28; 95% CI, 1.05-1.55; for each additional condition).

Their findings, the authors say, highlight the “need to engage this at-risk population in sustained cessation interventions.”

Reference: Parikh NS, Zhang C, Navi B, Kamel H. Risk and predictors of relapse after smoking cessation in patients with ischemic stroke and transient ischemic attack. Stroke. 2022;53(suppl1)TP183