Smoking during pregnancy associated with child’s risk of congenital heart disease

heart

Children born to mothers who smoked during pregnancy were at increased risk of congenital heart disease, a new study published today [27 May] in the Journal of the American Heart Association has found.

The study was led by University of Bristol, in an international collaboration with researchers from seven institutions. It brings together data on more than 230,000 families from seven European birth cohorts from the UK, Ireland, the Netherlands, Denmark, Norway and Italy, including the world-renowned Children of the 90s study at the University of Bristol. The research was supported by the British Heart Foundation and the H2020 program of the European Commission.

Each day, around 13 babies in the UK are diagnosed with congenital heart disease. This means the heart or the large blood vessels surrounding the heart have not developed properly in the womb. Identifying causes of congenital heart disease could help prevent some of these cases and ultimately save lives.

Lead author, Kurt Taylor, a Ph.D. student at the University of Bristol said: “Birth cohorts are unique in that many possess a wealth of data not only in mothers and children, but also in fathers. Crucially, having access to data in the fathers as well as mothers and children allowed us to use a novel study design to investigate possible causes of congenital heart disease.”

The study analysed associations between body mass index, smoking, and alcohol consumption on offspring congenital heart disease. Data on these characteristics were obtained through measurements of weight and height and questionnaires administered during early pregnancy when most of the cohorts began recruitment. Measurements were harmonised across cohorts as part of the LifeCycle project; an initiative that aims to research the role of pregnancy and infancy factors on offspring health and wellbeing across childhood and into adulthood. The researchers were able to test the reliability of their findings by using an approach that compares the results from mothers and fathers to help discern whether the effects they see are “real” or are as a result of other factors.

Kurt continued: “Here, we have shown that mothers who smoke during pregnancy are more likely to have a child with congenital heart disease. Our results also suggest that being overweight or obese at the start of pregnancy or consuming alcohol may not be causes of congenital heart disease, despite previous research suggesting otherwise. These results might help in supporting women of reproductive age not to start smoking. Meanwhile it continues to be appropriate to recommend that women, and men, maintain a healthy weight and limit alcohol consumption prior to and during pregnancy.”

Professor Deborah Lawlor, British Heart Foundation Chair in Cardiovascular Science and Clinical Epidemiology of the University of Bristol, who oversaw the study, added: “Smoking rates are declining but remain high in more deprived groups in the UK and other high-income countries and are promoted in low- and middle-income countries. These findings further highlight the need to support smoking cessation globally. Also, if we can work out exactly how maternal smoking increases risk of congenital heart diseases this could identify new ways of preventing these diseases even in the absence of smoking.”

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Renal, CV Damage May Develop in Mild SLE Despite Treatment

Patients with mild to moderate systemic lupus erythematosus (SLE) disease activity without any past history of organ damage may still progress to develop damage, particularly renal and cardiovascular disease, or death, in a relatively short amount of follow-up time, new research suggests.

The study, published in Lupus Science & Medicine, also showed that use of hydroxychloroquine lowered the risk of death and renal damage, whereas use of NSAIDs or any antihypertensives increased risk for cardiovascular damage.

“The impact of irreversible organ system damage in the prognosis of SLE remains a major concern because patients who develop damage are more likely to accrue additional damage and die,” wrote Deanna Hill, PhD, of GlaxoSmithKline, Collegeville, Pa., and coauthors, including Michelle Petri, MD, of Johns Hopkins University, Baltimore.

The researchers followed 1,168 adult patients with SLE from the Johns Hopkins Lupus Cohort, most of whom were women, 55% of whom were White and 39% of whom were Black. They divided the follow-up period into three parts: first year after enrollment into the cohort as background, second year as observation period, and the remainder of follow-up time until damage occurred, death, or end of available data.

At baseline, 55% of patients had mild to moderate disease, defined as an adjusted mean SELENA-SLEDAI (Safety of Estrogens in Lupus Erythematosus National Assessment SLE Disease Activity Index) score of less than 3. Patients had a median adjusted mean SELENA-SLEDAI score of 3 in the first year, which dropped to 2 in the observation period and remained there during the rest of follow-up.

Eight percent of patients died during the follow-up period. Each one-unit mean increase in SELENA-SLEDAI score during the 1-year observation period was associated with a significant 22% increase in the subsequent risk of death during the subsequent follow-up period (95% confidence interval, 1.13-1.32; P < .001).

Three-quarters of patients (n = 888) had no history of damage at the start of the follow-up period, but 39% of these patients had developed damage by the end of follow-up. Among patients without prior damage, a single-unit increase in disease activity score was also associated with a 9% increase in the risk of accruing organ damage (95% CI, 1.04-1.15; P < .001) after adjustment for confounding factors.

While only 3% of patients – most of whom were women – developed renal damage during the follow-up period, a one-unit increase in disease activity score was associated with a 24% increase in the risk of renal damage (95% CI, 1.08-1.42, P = .003).

The researchers found that 7% of patients developed cardiovascular damage during the follow-up period, and each one-unit increase in disease activity score was associated with a 17% increase in the risk of cardiovascular damage (95% CI, 1.07-1.29; P < .001).

“The findings in this analysis corroborate the influence of disease activity for renal and cardiovascular damage accrual and death and also extend the findings to patients with SLE and mild to moderate disease activity,” the authors wrote.

Impact of Treatment

Researchers also examined the effect of treatments, and found that patients treated with hydroxychloroquine during the 1-year observation period had a 54% lower risk of subsequent death (95% CI, 0.29-0.72; P < .05) and a 70% lower risk of renal damage (95% CI, 0.13-0.68, P < .05). However, patients prescribed NSAIDs had a 66% higher risk of cardiovascular damage, while those who used any antihypertensive had an 81% higher risk of cardiovascular damage.

“This may suggest that the known cardiovascular risk of NSAIDs in the general population is also applicable to patients with SLE and highlights the importance of assessing cardiovascular risk in this patient population,” the authors wrote.

Smoking affected the risk of death: Smokers were 74% more likely to die during the follow-up period than were nonsmokers.

There were no significant differences between different ethnicities in the study. While White patients generally had lower disease activity overall, there was no significant differences in the risk of death or organ damage with ethnicity.

The Hopkins Lupus Cohort is supported by the National Institutes of Health, and the study was funded by GlaxoSmithKline. Three authors were paid employees of GlaxoSmithKline and two were paid consultants or contractors.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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E-cigarettes with a cigarette-like level of nicotine are effective in reducing smoking

e-cigarette

E-cigarettes that deliver a cigarette-like amount of nicotine are associated with reduced smoking and reduced exposure to the major tobacco-related pulmonary carcinogen, NNAL, even with concurrent smoking, according to a new study led by researchers at Virginia Commonwealth University and Penn State College of Medicine in Hershey, Pennsylvania.

The study, which will be published in The Lancet Respiratory Medicine journal, provides new and important information for smokers who may be trying to use e-cigarettes as a means to cut down on their smoking habit and lower their exposure to harmful toxicants.

“[We found] e-cigarettes with nicotine delivery like a combustible cigarette were effective in helping reduce smoking and exposure to a tobacco-related carcinogen,” said lead author Caroline O. Cobb, Ph.D., an associate professor in the VCU Department of Psychology in the College of Humanities and Sciences. “But it doesn’t just happen by accident. It requires the smoker to be actively trying to reduce their smoking by replacing it with e-cigarette use.”

The researchers conducted a randomized controlled trial of 520 participants who smoked more than nine cigarettes a day, were not currently using an e-cigarette device, and were interested in reducing smoking but not quitting.

Over 24 weeks, participants used an e-cigarette device filled with either 0, 8 or 36 milligrams per milliliter of liquid nicotine or a plastic tube (shaped like a cigarette) that delivered no nicotine or aerosol. The e-cigarette conditions were chosen to reflect a range of nicotine delivery, either none, low (8 mg/ml) or cigarette-like (36 mg/ml). The participants were also provided with smoking reduction instructions.

At weeks 0, 4, 12 and 24, the researchers sampled participants’ urine, testing for the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, also known as NNAL. They found that participants using e-cigarettes filled with the cigarette-like level of liquid nicotine had significantly lower levels of NNAL at week 24 compared to baseline and compared to levels observed in the non-e-cigarette control condition.

The findings represent an important addition to the scientific literature because it suggests that when e-cigarettes deliver nicotine effectively, smokers have greater success in reducing their smoking and tobacco-related toxicant exposure. This study is important for two reasons, Cobb said.

“First, many e-cigarettes have poor nicotine delivery profiles, and our results suggest that those products may be less effective in helping smokers change their behavior and associated toxicant exposure,” she said.

“Second, previous randomized controlled trials examining if e-cigarettes help smokers change their smoking behavior/toxicant exposure have used e-cigarettes with low or unknown nicotine delivery profiles,” she said. “Our study highlights the importance of characterizing the e-cigarette nicotine delivery profile before conducting a randomized controlled trial. This work also has other important strengths over previous studies including the sample size, length of intervention, multiple toxicant exposure measures and control conditions.”

The question of whether an e-cigarette’s nicotine delivery profile is predictive of its ability to reduce harm and promote behavior change among smokers remains highly relevant to policymakers, public health advocates, health care providers and smoking populations. That knowledge will lead to better designed studies of the potential harms and benefits of e-cigarettes and ultimately inform tobacco regulatory policy, Cobb said.

The study contributes to the ongoing question of what role e-cigarettes play in changing smoking behavior.

Jonathan Foulds, Ph.D., professor of public health sciences at Penn State (one of the two study sites), commented, “This study shows that when smokers interested in reduction are provided with an e-cigarette with cigarette-like nicotine delivery, they are more likely to achieve significant decreases in tobacco-related toxicants, such as lower exhaled carbon monoxide levels.”

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New York Legalizes Recreational Marijuana Use

New York Gov. Andrew Cuomo on Wednesday signed a bill that legalizes the recreational use of marijuana for people 21 years and up.

The bill, approved Tuesday night by the state Legislature, immediately allows people to legally possess up to 3 ounces of marijuana or 24 ounces of concentrated forms of the drug, such as oils.

The bill creates new government oversight organizations for the recreational marijuana industry, which is expected to generate up to $350 million yearly in tax revenues, billions of dollars in sales, and thousands of new jobs, The New York Times reported.

The Marijuana Regulation and Taxation Act puts in place a 9% sales tax on cannabis, plus an additional 4% tax that counties and municipalities would split, Politico reported. There’s another tax based on THC content, Politico said.

The law will automatically expunge the criminal records for people who’d previously been convicted of possessing amounts of marijuana that would no longer be considered illegal. It will also establish new penalties for possessing and selling the drug outside the legal limits and incorporate marijuana impairment into driving while intoxicated laws, Politico reported.

New Yorkers will be able to receive home deliveries of marijuana and to grow up to six plants at home for personal use. 

“For too long the prohibition of cannabis disproportionately targeted communities of color with harsh prison sentences and after years of hard work, this landmark legislation provides justice for long-marginalized communities, embraces a new industry that will grow the economy, and establishes substantial safety guards for the public,” Cuomo said in a statement.

Politico said money raised by the tax would be invested in minority communities disproportionately affected by the state’s drug laws and used for drug treatment, prevention, and education.

Critics say the law will harm public health and safety, especially on the highways.

 “Even if you believe in the rights of adults to smoke a joint, this is a very bad bill,” Kevin Sabet, PhD, founder of SAM, Smart Approaches to Marijuana, said in a statement posted to Twitter. “This bill will exacerbate our state’s drug crisis.”

Sabet said the bill will end up exposing more children to second- and third-hand smoke and expose them to high levels of THC that are damaging to their brains. 

“I think this bill is going to end up costing us more than it benefits us,” New York State Assembly Member Robert Smullen said, according to Politico.

New York is now the 15th state to legalize the recreational use of marijuana and cannabis.

SOURCES:

Twitter: @NYGovCuomo, March 31, 2021; @learnaboutsam, March 30, 2021.

The New York Times: “New York Legalizes Recreational Marijuana.”

Politico: “New York Legislature votes to legalize adult-use, recreational cannabis.”

New York Governor’s Office: “Statement From Governor Andrew M. Cuomo on New York State Legislature Passing Legislation to Legalize Adult-Use Cannabis.”

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COVID-related smoking cessation messages effective in encouraging smokers to quit

An international survey that included 600 smokers in the UK has found that cessation messaging focused on easing the burden on our health system is most effective in encouraging people to quit.

The research, which was conducted in April-May 2020, randomly assigned participants to view one of four quit smoking messages, two of which explicitly referenced health implications and COVID-19, one referred more vaguely to risk of chest infection, and one highlighted financial motivations for quitting.

We wanted to explore the effectiveness of smoking cessation messaging at a time when health systems the world over are beleaguered, and all our lives have had to pivot into pandemic-response mode."

Professor Simone Pettigrew, Head of Food Policy, The George Institute for Global Health

All four messages were effective in terms of increasing participants' intentions to quit within a fortnight and prompting them to seek additional information around COVID-19 risk, with the two messages that specifically mentioned COVID-19 the most impactful:

  • MESSAGE A. By quitting now, you can reduce your chances of experiencing complications from the coronavirus if you become infected. This will help our overstretched health services to cope with the huge increase in patients.
  • MESSAGE B. Quit now – it's never too late. Smoking damages your lungs so they don't work as well. This means smokers are more likely to have severe complications if infected by the coronavirus.

Message A (referring to both personal consequences and to the impact on the functioning of the health system) landed best with participants, 34% of whom reported intention to quit and 44% sought additional information about the risks of COVID for smokers.

The latest figures from NHS England reflect a heavily loaded health system, with adult critical care bed occupancy at 67% across England. Public Health England is advising smokers to quit to improve their chances of avoiding infection and surviving COVID-19 if contracted.

This research can help tailor such communication for optimal impact, prioritizing messages that reference COVID-related health risk.

Source:

George Institute for Global Health

Journal reference:

Pettigrew, S., et al. (2021) The Potential Effectiveness of COVID-Related Smoking Cessation Messages in Three Countries. Nicotine & Tobacco Research. doi.org/10.1093/ntr/ntab023.

Posted in: Medical Research News | Healthcare News

Tags: Coronavirus, Critical Care, Health Systems, Lungs, Pandemic, Public Health, Research, Smoking, Smoking Cessation

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Guilt, Envy, Distrust: Vaccine Rollout Breeds Mixed Emotions

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

This image shows part of an Instagram post by Jeff Klein holding his COVID-19 vaccination card. The 44-year-old musician notes he was given a shot as a volunteer at a mass vaccination hub.

NEW YORK (AP) — Before posting a selfie with her COVID-19 vaccination card on Twitter, Aditi Juneja debated whether to include an explanation for why she was eligible for a shot.

“The first draft of the tweet had an explanation,” says Juneja, a 30-year-old lawyer in New York City.

After some thought, she decided to leave out out that her body mass index is considered obese, putting her at higher risk of serious illness if infected. A friend who disclosed the same reason on social media was greeted with hateful comments, and Juneja wanted to avoid that.

The rollout of COVID-19 vaccines in the U.S. is offering hope that the pandemic that has upended life around the world will finally draw to an end. But as distribution widens in the U.S., varying eligibility rules and unequal access to the coveted doses are also breeding guilt, envy and judgment among those who’ve had their doses — particularly the seemingly young and healthy — and the millions still anxiously awaiting their turn.

Adding to the second-guessing about who should be getting shots is the scattershot feel of the rollout, and the sense that some might be gaming the system. Faced with a patchwork of confusing scheduling systems, many who aren’t as technically savvy or socially connected have been left waiting even as new swaths of people become eligible.

The envy and moral judgments about whether others deserve to be prioritized are understandable and could reflect anxieties about being able to get vaccines for ourselves or our loved ones, says Nancy Berlinger, a bioethicist with the Hastings Center.

“There’s the fear of missing out, or fear of missing out on behalf of your parents,” she says.

Stereotypes about what illness looks are also feeding into doubts about people’s eligibility, even though the reason a person got a shot won’t always be obvious. In other cases, Berlinger says judgments could reflect entrenched biases about smoking and obesity, compared with conditions that society might deem more “virtuous,” such as cancer.

Yet even though a mass vaccination campaign is bound to have imperfections, Berlinger noted the goal is to prioritize people based on medical evidence on who’s most at risk if infected.

Nevertheless, the uneven rollout and varying rules across the country have some questioning decisions by local officials.

In New Jersey, 58-year-old software developer Mike Lyncheski was surprised when he learned in January that smokers of any age were eligible, since he knew older people at the time who were still waiting for shots.

“It didn’t seem like there was medical rationale for it,” says Lyncheski, who isn’t yet eligible for the vaccines. He also noted there’s no way to confirm that people are smokers, leaving the door open for cheating.

The suspicions are being fueled by reports of line jumpers or those stretching the definitions for eligibility. In New York, a Soul Cycle instructor got vaccinated after teachers became eligible in January, the Daily Beast reported, and later apologized for her “terrible error” in judgment. In Florida, two women wore bonnets and glasses to disguise themselves as elderly in hopes of scoring shots. Hospital board members, trustees and donors have also gotten shots early on, raising complaints about unfair access.

It’s why some feel obligated to explain why they were able to get the vaccine. In an Instagram post, Jeff Klein held up his vaccination card and noted he was given a shot as a volunteer at a mass vaccination hub.

“I definitely mentioned it on purpose, because I didn’t want people to get the wrong idea,” says Klein, a 44-year-old musician in Austin, Texas.

As she waited for a shot in Jacksonville, Florida, 33-year-old Amanda Billy said it could be frustrating seeing people her age in other states posting about getting vaccinated. She understood that state rollouts vary, but felt anxious because she has a medical condition that makes COVID-19 “very real and scary.”

“I’m just happy for them that they got it. But also, I want it,” she said in an interview before getting her first shot.

Others are finding they are opening themselves up to criticism when sharing news that they got a shot. Public figures in particular might become targets of second-guessing by strangers.

In New York, local TV news co-host Jamie Stelter posted a photo of herself after getting the first shot earlier this month. Many replies were positive, but others noted that she didn’t look old enough or that she must “have connections.”

Afterward, Stelter’s co-host Pat Kiernan weighed in and tweeted that the “you don’t look that sick to me” commentary she received was “evidence of the hell that COVID has placed us in.”

For Juneja, the decision to get a shot after becoming eligible wasn’t easy, given the struggles she knew others were having securing appointments because of technology, language or other barriers. But she realized it wouldn’t help for her to refrain from getting vaccinated.

“It’s not like with other types of things where I could give my spot to someone else who I think is more in need,” she says. “We are sort of all in this situation where we can only really decide for ourselves.”

Candice Choi, a reporter on The Associated Press’ Health & Science team, has been covering the pandemic and vaccine rollout in the United States.

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40% of countries show no progress in reducing cigarette smoking in adolescents over last 20 years

cigarette smoke

Despite an overall reduction in cigarette use over the last 20 years, nearly 1 in 5 boys (17.9%) and more than 1 in 10 girls (11.5%) around the world used tobacco at least once in the past month between 2010-2018, according to a new study published today in The Lancet Child & Adolescent Health journal.

Tobacco use kills more than 8 million around the world every year and can lead to cancer, heart disease, lung disease, and chronic obstructive pulmonary disease, as well as affect fertility. Tobacco use among adolescents and children is a crucial problem, given that most adult smokers start in adolescence or childhood.

In the new study, the authors looked at the Global Youth Tobacco Surveys data between 1999 and 2018 to assess trends in prevalence of tobacco use. All countries included did at least two surveys, resulting in 1.1 million 13-15-year-olds from 140 countries included between 1999-2018, and 530,000 adolescents from 143 countries between 2010-2018.

In the study, the prevalence between 2010 and 2018 of smoking cigarettes on at least one day in the past 30 days was approximately twice as high at age 15 years compared with age 13 years in both boys and girls (6.8% vs 15.4% in boys; 3.4% vs 8.7% in girls). The prevalence of cigarette smoking was highest in the Western Pacific region for boys (17·6%), with Tokelau having the highest prevalence of 49.3%. The European region had the highest prevalence of cigarette smoking for girls (9·0%), with a prevalence of 23.7% in Bulgaria and 23.6% in Italy.

The study also looked at the use of other tobacco products, such as chewing tobacco, snuff, dip, cigars, cigarillos, pipe, or electronic cigarettes.

Between 2010 and 2018, the prevalence of using these products was higher at age 15 years than at 13 years (8.4% vs. 13.9% in boys, 5.1% vs. 9.3% in girls), and there was a significant increase in using other tobacco products among boys aged 15 over the past 20 years, where it rose by an estimated 2.1%. The prevalence of using tobacco products other than cigarettes was highest in the Eastern Mediterranean region (16.7% in boys and 9.0% in girls). The Americas and European regions had the lowest prevalence (7.5% and 9.3% among boys and 5.4% and 5.5% among girls respectively), according to the study. The authors note that they could not distinguish between the different types of tobacco products in this category.

Prof Bo Xi, of Shandong University, China, and lead author of the study, said: “Cigarette use may have decreased in the majority of countries in the study, but there are still large numbers of young people smoking. The fact that in many countries the prevalence of using non-cigarette tobacco products is higher than, or as high as, the prevalence of cigarette use shows us there is still a lot of work to do. The need to strengthen tobacco control efforts, which include specific policies for different tobacco products and a focus on health education for adolescents globally is more important than ever.”

In the study there was varying prevalence of smoking cigarettes and using other tobacco products across different regions, which the researchers suggest was due to differences in how tobacco control measures are implemented and monitored. For example, Uruguay has been at the forefront of tobacco control, with a complete ban on tobacco promotion and advertising and strict pictorial health warnings. As a result, cigarette smoking reduced by 17% per 10 calendar years (from 20.1% in 2007 to 8% in 2014), the authors estimate.

The Western Pacific region showed improvement in the prevalence of smoking cigarettes and use of other tobacco between 1999 and 2018 where it reduced by 6.2% and 4.2%, respectively, per 10 calendar years. The prevalence of cigarette smoking also reduced in the European region by 5%. However, even though the region showed improvement, not all countries within the regions performed as well. For example, Bosnia and Herzegovina saw an increase of 10.6% every 10 years (from 11.7% in 2008 to 17% in 2013). The authors suggest that possible reasons for an increase in smoking in this country and some others could be due to the low cost of cigarettes, poor enforcement of smoking bans inside buildings, weak measures on tobacco advertising and promotion, or the sale of single cigarettes.

There were regions that showed an increase in prevalence of using other tobacco products. In the Eastern Mediterranean region, the prevalence increased by 3.5% and in the South-East Asia region it increased by 3.3% per 10 calendar years. For example, in Saudi Arabia in the Eastern Mediterranean region, the prevalence of using other tobacco products increased by 33.3% every 10 years (from 11.2% in 2007 to 21.2% in 2010). In Bhutan in South-East Asia it increased by 18% (from 7.2% in 2004 to 23.4% in 2013).

Professor Yajun Liang, of the Karolinska Institute, Sweden, said: “The largest reductions in tobacco use were seen in countries which had ratified the WHO Framework Convention on Tobacco Control, highlighting the importance of policy change to reduce tobacco smoking. But there is still a lot of work to be done especially with reducing the use of other tobacco products.”

“The prevalence of using any tobacco product was two or three times higher in adolescents aged 15 than aged 13 in most countries. Peer pressure, the desire to experience new things, and the ability to buy cigarettes could all explain this trend. Fortunately, many countries have implemented partial or total bans on tobacco advertising. However, it is challenging to address advertising or promotions on the internet and on social media. Health education from an early age about the dangers of tobacco remain crucial.”

In a linked Comment, co-authors Mohammed Jawad and Christopher Millett of Imperial College London, UK, and Rima Nakkash, of American University of Beirut, Lebanon, (who were not involved in the study) say that the study “portrays a somber situation” and “[the] findings uncovered a quietly growing phenomenon that has manifested into an urgent priority for the global tobacco-control agenda: the rise of non-cigarette tobacco products.”

They discuss in depth the rise in the use of other tobacco products in the Eastern Mediterranean region and suggest this is due to the growing popularity of the waterpipe (known locally as shisha, hookah, or arghile) as a result of new flavoured tobacco, a thriving Middle Eastern café culture, and the misperception that waterpipe tobacco is less harmful than cigarettes. They agree with the study authors that different policies may be needed for different tobacco products and that existing tobacco control laws are based on reducing cigarette smoking and are less effective when applied to products such as waterpipe tobacco.

The authors write: “Simply extending existing laws to waterpipe tobacco seems reasonable in theory, but in practice is far from adequate and can be unenforceable. In the absence of an effective policy response to the emergence of a more nuanced tobacco-use landscape, tobacco consumption among adolescents will remain high… It is not yet certain whether plateaued trends in cigarette use among adolescents in the Eastern Mediterranean region were caused by increasing waterpipe tobacco use, but it is certainly plausible. At a minimum, rising non-cigarette tobacco use is likely to undermine the progress made in reducing cigarette smoking, and at worst could sizably exacerbate the tobacco epidemic.”

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Do Migraines Increase Risk of Stroke?

Skip to:

  • What is a stroke?
  • Migraines: causes and treatments
  • Migraines and strokes
  • Can migraines contribute to strokes?

Migraines and strokes are neurological disorders, and those affected by migraines are known to be at increased risk of stroke. However, an explanation for this association remains elusive. It is not yet known whether migraine itself predisposes to stroke, or whether persons affected by migraines have another, unknown risk factor that increases their risk of stroke.

What is a stroke?

A stroke occurs when the blood supply to the brain is interrupted. This causes affected neurons and other brain cells to be starved of oxygen, killing them.

There are three main types of strokes; Ischemic stroke, hemorrhagic stroke and transient ischemic attack (a warning or “mini-stroke”). A hemorrhagic stroke results from a burst blood vessel in the brain that causes a bleed around the local area.

The causes of hemorrhagic strokes include high blood pressure, and to a lesser extent and brain aneurysms (rupturing of balloon-like expanses of blood vessels). Ischaemic strokes are more common and are characterized by the blockage of blood flow to regions of the brain due to a blood clot.

Blood clot in the human brain. Ischemic stroke in the cerebral artery and thrombus Image Credit: Designua / Shutterstock

These blood clots can be formed due to atherosclerosis deposits in the blood vessel of the brain or due to the lodging of a blood clot that has travelled from another area of the body.

Risk factors for ischaemic strokes include smoking, high blood pressure, obesity, high blood cholesterol, and diabetes mellitus.

Migraines: causes and treatments

Migraines are a form of moderate/severe headache that affects approximately 20% of women and 6.67% of men. There are several types of migraine which vary based on the expression.

Image Credit: Mykola Samoilenko / Shutterstock

Migraines that have warning signs before the migraine attack begins are called migraine with aura. Migraines without prior warning signs are called migraine without aura.

Silent migraines are migraines without headaches but with other migraine symptoms. Some of the other symptoms of migraines are feeling/being sick, increased photosensitivity, increased noise sensitivity (hyperacusis), poor concentration, and abdominal pain.

Additionally, the warning signs before an aura/silent migraine range from vision problems, to dizziness, and even difficulty speaking and loss of consciousness.  Some of these symptoms resemble stroke symptoms.

Migraines usually progress in stages, although not all stages are met or expressed in order for every migraine, even in the same patient. These stages are;

  1. Prodrome – changes in mood, energy levels, or behavior before a migraine attack.
  2. Aura – the warning signs that occur before a migraine attack occurs (such as visual changes). Migraine without aura attacks does not express this stage.
  3. Headache – Pulsating/throbbing pain originating in the head, which can also be accompanied by additional symptoms, as previously discussed. These are often one-sided but can be bilateral.
  4. Resolution – when the symptoms begin to fade and the migraine attack ends.  

Migraines and strokes

Migraines and strokes are heavily linked as they are both neurovascular disorders with similar physiological properties.

Migrainous infarction is the occurrence of a stroke during a migraine attack, with symptoms that persist for longer than 60 minutes. The incidence of this disorder is exceptionally low, with only 0.2-0.5% of all ischaemic stroked being migrainous infarction.

The posterior blood circulation of the brain is more affected than the anterior circulation during a migrainous infarction. This results in visual deficits, sensory deficits, inability to form/comprehend language (aphasia), weakness of one side of the body (hemiparesis), and weakness of all four limbs (tetraparesis).

The prognosis for migrainous infarctions is favourable, with most cases showing a complete recovery.

One theory for the relationship between  migraine and stroke is the cortical spreading depression (CSD) hypothesis. This theory suggests that a decrease in cerebral blood volume starts during the aura phase of a migraine and spreads anteriorly through the brain; this stage is followed by an increase in blood flow to different tissues. Ultimately, this results in the migraine aura attack. Patients with migraine without aura show posterior hypoperfusion.

A potential response to CSD is severe vasoconstriction instead of vasodilation, which is detrimental to the health of the brain. Due to the low incidence of migrainous infarctions and the high incidence of migraines, is it clear that the cerebral blood flow during a CSD does not cause ischaemic stroke in the vast majority of cases. This suggests that CSD may only be a factor of migrainous infarctions instead of a direct cause.

Can migraines contribute to strokes?

Population studies have shown that patients with migraines are twice as likely to suffer from an ischaemic stroke compared to individuals that do not suffer from migraines.

Risk factors for migrainous infarction include young age (under 45 years of age), being female, smoking, and use of oral contraceptives.

An important distinction is that increase risk of strokes due to migraines has only been observed with migraine aura, with migraine without aura showing no increased risk. Theories discussing the increased risk of ischaemic stroke and migraines include:

  • The migraine predisposing an individual to ischemic strokes
  • Common comorbidities between migraine and stokes
  • Certain genetic disorders associated with migraines and strokes
  • Migraine-specific medication – I.e. vasoconstrictors – that increase the risk of a stroke

As of 2015, 38 different gene loci have been linked to migrainous infarctions. One of those is a polymorphism in the methylenetetrahydrofolate reductase gene. This gene is responsible for the metabolism of folate and homocysteine and is associated with increased susceptibility to migraine auras.

Cerebral Autosomal Dominant Arteriopathy with subcortical infracts and leukoencephalopathy (CADASIL) is a disorder of small cerebral arteries that is associated with migraines and ischaemic strokes. Ischaemic strokes occur in approximately 60%-85% of patients with CADASIL.

Mitochondrial encephalopathy lactic acidosis and stroke-like episodes are a genetic heterogeneous mitochondrial disorder which results in many neurological symptoms mainly affecting the central nervous system. This includes seizures, cortical blindness, episodic vomiting, migraines, and stroke-like episodes.

Sources

  • nhs.uk. (2019). Stroke. https://www.nhs.uk/conditions/stroke/
  • Lee, M., et al. (2016). The Migraine–Stroke Connection. Journal of Stroke. https://dx.doi.org/10.5853%2Fjos.2015.01683
  • Migraine and Stroke: What’s the Link? What to Do? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346116/
  • Stroke and migraine is there a possible comorbidity? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845315/

Further Reading

  • All Migraine Content
  • What are Migraines?
  • Migraine Diagnosis
  • Migraine Pathophysiology
  • Migraine History
More…

Last Updated: Oct 20, 2019

Written by

Samuel Mckenzie

Sam graduated from the University of Manchester with a B.Sc. (Hons) in Biomedical Sciences. He has experience in a wide range of life science topics, including; Biochemistry, Molecular Biology, Anatomy and Physiology, Developmental Biology, Cell Biology, Immunology, Neurology  and  Genetics.

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USPSTF affirms evidence-based methods for smoking cessation

USPSTF affirms evidence-based methods for smoking cessation

The U.S. Preventive Services Task Force (USPSTF) concludes that there is substantial net benefit for behavioral and pharmacological therapies for smoking cessation, alone or combined. These findings form the basis of a final recommendation statement published in the Jan. 19 issue of the Journal of the American Medical Association.

Carrie D. Patnode, Ph.D., M.P.H., from the Kaiser Permanente Evidence-based Practice Center in Portland, Oregon, and colleagues conducted a systematic review of tobacco cessation interventions for adults. The researchers found that compared with minimal support or placebo, combined pharmacotherapy and behavioral interventions (pooled risk ratio [RR], 1.83), nicotine replacement therapy (NRT; RR, 1.55), bupropion (RR, 1.64), varenicline (RR, 2.24), and behavioral interventions, including clinicians’ advice (RR, 1.76), were associated with increased quit rates at six months or longer. No serious adverse events were seen with any of the drugs. Inconsistent findings were seen for the effectiveness of electronic cigarettes on smoking cessation at six or 12 months compared with placebo or NRT. Behavioral interventions were associated with greater smoking cessation during late pregnancy compared with no intervention (RR, 1.35).

Based on these findings, the USPSTF concludes that behavioral interventions and pharmacotherapy have net benefit for tobacco smoking cessation—alone or in combination—for nonpregnant adults who smoke. The net benefit of behavioral interventions for tobacco smoking cessation in pregnant persons is substantial. The current evidence on use of e-cigarettes for tobacco smoking cessation is inadequate for assessing the balance of benefits and harms.

“The good news is there are multiple safe and proven ways to help adults quit tobacco, including counseling, medications, or a combination of both,” USPSTF member Michael Silverstein, M.D., M.P.H., said in a statement.

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How much money could you save in a year by giving up smoking?

how much money could you save by giving up smoking?

There are many reasons to give up smoking (your health being the big one).

Sometimes, though, only cold, hard cash provides enough motivation to make a change.

So it’s worth noting, we reckon, that you really can save quite a bit of money by ditching your regular cigarettes.

If you’re buying just a pack of Silk Cut for £13.40 a week, for example, ditching that habit will save you £698 in a year.

Think about what treats you could buy yourself with that extra cash?

If you’re smoking more than a pack a week, the amount of money you could stash away only increases – along with all the other benefits of quitting the cigs.

You can work out exactly how much you could save by ditching smoking with our handy calculator below.

Then please do use that as motivation to finally quit. It’s well worth it.

(Please note, if the calculator isn’t showing up in this article, try opening the link in a new tab on your phone or laptop)

How much could you save by giving up smoking?

Benefits of quitting smoking:

Beyond saving money, here are a few more benefits you can gain by ditching cigarettes:

  • Improved lung capacity – meaning easier breathing
  • More energy
  • A boosted immune system
  • Exercise becomes easier
  • Lower stress levels
  • Better sex
  • Improved fertility
  • Boosted smell and taste
  • Younger-looking skin
  • Whiter teeth
  • Longer life
  • Reduced risk of lung cancer

If you want more tips and tricks on saving money, as well as chat about cash and alerts on deals and discounts, join our Facebook Group, Money Pot.

Do you have a story to share?

Get in touch by emailing [email protected]

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