Smoking and stroke: what the evidence shows and who treats it

A stroke is one of the most serious outcomes linked to smoking, and it is also one where the evidence on quitting is encouraging. The American Stroke Association says current smokers have a 2 to 4 times increased risk of stroke compared with nonsmokers or those who have quit for more than 10 years. The World Health Organization's 2016 summary Tobacco and Stroke reports a 12-year follow-up study that found a 34% decreased risk of stroke for former smokers compared with current smokers. This page covers what a stroke is, what smoking does to risk, how risk falls after quitting, the warning signs, recovery, and who treats stroke. It is educational only. The Quit Ledger offers no medical services and cannot assess symptoms, and stroke symptoms need emergency care.

What a stroke is

The CDC describes a stroke as something blocking blood supply to part of the brain, or a blood vessel in the brain bursting. In either case, parts of the brain become damaged or die. The CDC identifies two main types. An ischemic stroke, called ischaemic in British spelling, happens when blood clots or other particles block the blood vessels to the brain, and the CDC says most strokes are of this kind. A hemorrhagic stroke, or haemorrhagic, happens when an artery in the brain leaks blood or ruptures.

A third event, a transient ischemic attack (TIA), is sometimes called a mini-stroke. The CDC says blood flow is blocked for only a short time, usually no more than 5 minutes, and that a TIA is a medical emergency and a warning sign of a future stroke.

How much smoking raises stroke risk

The American Stroke Association gives the 2 to 4 times figure quoted above. The WHO summary agrees, stating that smoking increases the risk of stroke two to fourfold, both among men and women, and that the higher the number of cigarettes smoked, the higher the risk. It also reports that tobacco smoking is responsible for 17.6% of premature deaths due to cerebrovascular disease among adults aged 30 to 60, and that two fifths of all stroke deaths under the age of 65 are linked to smoking.

The CDC's stroke risk factors page lists mechanisms. Cigarette smoking can damage the heart and blood vessels, nicotine raises blood pressure, and carbon monoxide from cigarette smoke reduces the amount of oxygen the blood can carry. It adds that exposure to secondhand smoke can make a person more likely to have a stroke, and the CDC's secondhand smoke page puts the increase in stroke risk for exposed adults who do not smoke at 20 to 30%. Smoking is one factor among several, alongside high blood pressure, high cholesterol, diabetes, age and family history.

How risk falls after quitting

The WHO summary reports that, in the 12-year follow-up study, former smokers who had stopped for two to four years had an almost identical risk of stroke as lifetime non-smokers. It also cites the US Surgeon General's reports for the finding that within four to five years of quitting, stroke risk is reduced to that of a non-smoker. The CDC, drawing on the 2020 Surgeon General's report Smoking Cessation, says quitting reduces the risk of disease and death from stroke, with risk approaching that of never smokers after cessation. In its time-point table it places a decrease in stroke risk at 5 to 10 years. These timescales differ between sources and between studies, and our timeline of what happens after you quit sets out the agencies' figures side by side.

None of this means it is safe to wait. The choice of quit method is covered in quit methods compared, with phone and text support described under counselling and quitlines. Family and friends can find advice in supporting someone who is quitting.

Warning signs and emergency action

The CDC lists these signs: sudden trouble walking, dizziness, loss of balance or lack of coordination; sudden trouble seeing; sudden numbness or weakness in the face, arm or leg, especially on one side; sudden confusion, trouble speaking or difficulty understanding speech; and sudden severe headache with no known cause. It teaches a B.E. F.A.S.T. check covering balance, eyes, face, arms, speech and time, and says to call 9-1-1 right away. The NHS uses the shorter FAST test of face, arms, speech and time to call 999.

Call your local emergency number immediately, without waiting to see whether symptoms pass. The CDC says the stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms, that you should note the time symptoms first appear, and that you should not drive to the hospital or let someone else drive you. The NHS says to call 999 even if signs have stopped within the last 24 hours. This page cannot tell anyone whether symptoms are a stroke.

Recovery and rehabilitation

According to the CDC's treatment page, rehabilitation begins in the hospital, often within a day or 2 after the stroke. Recovery time is different for everyone and can take weeks, months or even years. Some people recover fully, while others have long-term or lifelong disabilities. The CDC lists lasting problems such as one-sided weakness, memory trouble and depression.

Rehab can include speech, physical and occupational therapists, and the CDC says support groups and family support can help. It also warns that a person who has had a stroke is at high risk of another: it reports that 1 in 4 stroke survivors has another stroke within 5 years. Treating the underlying causes, such as high blood pressure, is part of care, and tobacco use is a modifiable one.

Who treats stroke

Care is a chain of people rather than one specialist. Emergency medical services start treatment on the way to the hospital and may take a patient to a specialized stroke center. At the hospital, the CDC says brain scans show the type of stroke and the patient may be seen by a neurologist, who treats brain disorders, a neurosurgeon, who performs surgery on the brain, or a specialist in another area of medicine. After the acute phase, rehabilitation therapists work on speech, movement and daily tasks, while primary care clinicians and the wider health care team help manage blood pressure, cholesterol, diabetes and tobacco use over the long term.

Follow-up after a stroke or neurological symptoms

Once the emergency is over, many people are left with questions about lingering symptoms such as weakness, changes in vision or speech, memory difficulty or numbness, and about how to prevent another stroke. The CDC advises people to discuss their treatment plan regularly with their health care team and to bring a list of questions to appointments. A reader with lingering symptoms or in need of stroke follow-up can ask their primary clinician for a referral to a neurologist, and a web search for top neurologists near me is a common starting point, including for readers in the US Virgin Islands. New or sudden symptoms are different from follow-up: they call for emergency care, not an appointment.

The short version

Smoking raises stroke risk two to fourfold according to WHO and the American Stroke Association, and quitting lowers it, with WHO reporting close to non-smoker risk within a few years. Sudden face, arm, speech, vision or balance changes are an emergency: call your local emergency number. For ongoing symptoms, medicines or quitting support, speak with your own clinician or pharmacist.