title: Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes.
abstract: OBJECTIVE
  It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men.
  
  
  METHODS
  PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled.
  
  
  RESULTS
  Data from 81 prospective cohort studies that included 3,980,359 individuals and 42,401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99-1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02-1.18)] but not in Asian (RRR, 0.97 [0.87-1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99-1.22]).
  
  
  CONCLUSIONS
  Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.
authors: From The George Institute for Global Health, University of Sydney, New South Wales, Australia (S.A.E.P., R.R.H., M.W.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (R.R.H.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.).
authors: Sanne A E
authors: SA
authors: Peters
authors: Rachel R
authors: RR
authors: Huxley
authors: Mark
authors: M
authors: Woodward
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D039781:PubMed; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
keywords: meta-analysis; risk factors; sex differences; smoking; stroke