title: Cigarette smoking as a determinant of high-grade carotid artery stenosis in Hispanic, black, and white patients with stroke or transient ischemic attack.
abstract: OBJECTIVE
  We sought to investigate the association of cigarette smoking with high-grade carotid artery stenosis in Hispanic, black, and white patients with cerebral ischemia in two independent samples.
  
  
  METHODS
  Prospectively collected data from the Northern Manhattan Stroke Study (NOMASS) (n=431) and the Berlin Cerebral Ischemia Databank (BCID) (n=483) were used separately for a cross-sectional study estimating the association between cigarette smoking and high-grade carotid stenosis (defined as a luminal narrowing of > or =60%, diagnosed by duplex and/or Doppler ultrasound). In both studies, cerebral ischemia patients with normal sonographic findings or nonstenosing plaques of their carotid arteries served as a comparison group. Multivariate logistic regression models were used for statistical tests to determine the association between smoking and the dependent variable for high-grade carotid stenosis. Age, sex, hypertension, diabetes, hypercholesterolemia, and race/ethnicity were considered potential confounders. Further analyses of the NOMASS data estimated the effect of the amount of cigarette use and the impact of race/ethnicity.
  
  
  RESULTS
  High-grade carotid stenoses were found in 14% of the NOMASS and in 21% of the Berlin patients. In Berlin the entire sample was white, whereas in New York only 19% of the cohort were white. In both samples, smoking was independently associated with severe carotid stenosis (NOMASS: odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1 to 2.0; BCID: OR, 3.9; 95% CI, 2.4 to 6.4). Patients smoking 20 pack-years or more showed a significant association (OR, 2.0; 95% CI, 1.1 to 3.9), whereas no significant effect was found for lower amounts of cigarette use. In NOMASS, white smokers displayed a significant (OR, 3.2; 95% CI, 1.1 to 8.9) association with high-grade carotid stenosis, the association for black smokers was less strong, and no association was found among Hispanics.
  
  
  CONCLUSIONS
  Smoking is an independent determinant of severe carotid artery stenosis in patients with focal cerebral ischemia. The association differs by race/ethnicity, with the greatest effect observed among whites.
authors.affiliation: Stroke Unit, The Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032, USA. ah267@columbia.edu
authors.forename: H
authors.initials: H
authors.lastname: Mast
authors.forename: J L
authors.initials: JL
authors.lastname: Thompson
authors.forename: I F
authors.initials: IF
authors.lastname: Lin
authors.forename: C
authors.initials: C
authors.lastname: Hofmeister
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
authors.forename: P
authors.initials: P
authors.lastname: Marx
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.forename: R L
authors.initials: RL
authors.lastname: Sacco
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001604:Berlin / Q000453:epidemiology; D044383:Black People; D016893:Carotid Stenosis / Q000150:complications / Q000208:ethnology* / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000208:ethnology*; D003627:Data Interpretation, Statistical; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006937:Hypercholesterolemia / Q000208:ethnology; D006973:Hypertension / Q000208:ethnology; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*; D044465:White People / Q000706:statistics & numerical data