This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

The Framingham Study

Philip A. Wolf, MD; Ralph B. D'Agostino, PhD; William B. Kannel, MD; Ruth Bonita, MPH, PhD; Albert J. Belanger

JAMA. 1988;259(7):1025-1029.

Abstract
The impact of cigarette smoking on stroke incidence was assessed in the Framingham Heart Study cohort of 4255 men and women who were aged 36 to 68 years and free of stroke and transient ischemic attacks. During 26 years of follow-up, 459 strokes occurred. Regardless of smoking status and in each sex, hypertensive subjects had twice the incidence of stroke. Using the Cox proportional hazard regression method, smoking was significantly related to stroke after age and hypertension were taken into account. Even after pertinent cardiovascular disease risk factors were added to the Cox model, cigarette smoking continued to make a significant independent contribution to the risk of stroke generally and brain infarction specifically. The risk of stroke increased as the number of cigarettes smoked increased. The relative risk of stroke in heavy smokers (>40 cigarettes per day) was twice that of light smokers (fewer than ten cigarettes per day). Lapsed smokers developed stroke at the same level as nonsmokers soon after stopping. Stroke risk decreased significantly by two years and was at the level of nonsmokers by five years after cessation of cigarette smoking.

(JAMA 1988;259:1025-1029)

Author Affiliations
From the Department of Neurology (Dr Wolf) and Section of Preventive Medicine and Epidemiology, Evans Memoria Department of Clinical Research and Department of Medicine (Drs Wolf and Kannel), University Hospital, School of Medicine, and the Department of Mathematics (Dr D'Agostino and Mr Belanger), Boston University; and the Department of Medicine, School of Medicine, University of Auckland (New Zealand) (Dr Bonita).

Footnotes
Reprint requests to Department of Neurology, Boston University Medical Center, 720 Harrison Ave. Suite 1105, Boston, MA 02118 (Dr Wolf).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Initial management of suspected transient cerebral ischaemia and stroke in primary care: implications of recent research
Lasserson
Postgrad. Med. J. 2009;85:422-427.
ABSTRACT | FULL TEXT  

Fibrinogen Independently Predicts the Development of Ischemic Stroke in a Taiwanese Population: CVDFACTS Study
Chuang et al.
Stroke 2009;40:1578-1584.
ABSTRACT | FULL TEXT  

Secondary Prevention of Atherothrombotic Events After Ischemic Stroke
Adams
Mayo Clin Proc. 2009;84:43-51.
ABSTRACT | FULL TEXT  

Characterisation of smoking behaviour across the life course and its impact on decline in lung function and all-cause mortality: evidence from a British birth cohort
Clennell et al.
J. Epidemiol. Community Health 2008;62:1051-1056.
ABSTRACT | FULL TEXT  

Incidence and Risk Factors for Stroke in American Indians: The Strong Heart Study
Zhang et al.
Circulation 2008;118:1577-1584.
ABSTRACT | FULL TEXT  

Dose-Response Relationship Between Cigarette Smoking and Risk of Ischemic Stroke in Young Women
Bhat et al.
Stroke 2008;39:2439-2443.
ABSTRACT | FULL TEXT  

Rho-kinase inhibitor and Nicotinamide Adenine Dinucleotide PHosphate oxidase inhibitor prevent impairment of endothelium-dependent cerebral vasodilation by acute cigarette smoking in rats
Iida et al.
Journal of Renin-Angiotensin-Aldosterone System 2008;9:89-94.
ABSTRACT  

Cigarette Smoking, Systolic Blood Pressure, and Cardiovascular Diseases in the Asia-Pacific Region
Nakamura et al.
Stroke 2008;39:1694-1702.
ABSTRACT | FULL TEXT  

Cigarette Smoking and Risk of Stroke in the Chinese Adult Population
Kelly et al.
Stroke 2008;39:1688-1693.
ABSTRACT | FULL TEXT  

Prevention of stroke
Simon
InnovAiT 2008;1:305-313.
FULL TEXT  

Smoking, quitting and mortality in an elderly cohort of 56 000 Hong Kong Chinese
Lam et al.
Tobacco Control 2007;16:182-189.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Rosamond et al.
Circulation 2007;115:e69-e171.
FULL TEXT  

ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting)
Bates et al.
Vasc Med 2007;12:35-83.
 

ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting)
American Society of Interventional & Therapeutic N et al.
J Am Coll Cardiol 2007;49:126-170.
FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Circulation 2006;113:e873-e923.
ABSTRACT | FULL TEXT  

Risk awareness and knowledge of patients with stroke: results of a questionnaire survey 3 months after stroke
Croquelois and Bogousslavsky
J. Neurol. Neurosurg. Psychiatry 2006;77:726-728.
ABSTRACT | FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Stroke 2006;37:1583-1633.
ABSTRACT | FULL TEXT  

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.
Sacco et al.
Circulation 2006;113:e409-e449.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Thom et al.
Circulation 2006;113:e85-e151.
FULL TEXT  

Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm
Raupach et al.
Eur Heart J 2006;27:386-392.
ABSTRACT | FULL TEXT  

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.
Sacco et al.
Stroke 2006;37:577-617.
ABSTRACT | FULL TEXT  

Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence?
Paraskevas et al.
ANGIOLOGY 2005;56:539-552.
ABSTRACT  

Smoking Cessation and Mortality from Cardiovascular Disease among Japanese Men and Women: The JACC Study
Iso et al.
Am J Epidemiol 2005;161:170-179.
ABSTRACT | FULL TEXT  

PROTECT: A coordinated stroke treatment program to prevent recurrent thromboembolic events
Ovbiagele et al.
Neurology 2004;63:1217-1222.
ABSTRACT | FULL TEXT  

Secondary Prevention Strategies in Ischemic Stroke: Identification and Optimal Management of Modifiable Risk Factors
Flemming and Brown
Mayo Clin Proc. 2004;79:1330-1340.
ABSTRACT  

Cigarette Smoking as a Risk Factor for Stroke Death in Japan: NIPPON DATA80
Ueshima et al.
Stroke 2004;35:1836-1841.
ABSTRACT | FULL TEXT  

Cigarette Smoking and Risk of Stroke and its Subtypes Among Middle-Aged Japanese Men and Women: The JPHC Study Cohort I
Mannami et al.
Stroke 2004;35:1248-1253.
ABSTRACT | FULL TEXT  

Influence of Smoking on Predictors of Vascular Disease
Tsiara et al.
ANGIOLOGY 2003;54:507-530.
ABSTRACT  

Differences in Vascular Risk Factors Between Etiological Subtypes of Ischemic Stroke: Importance of Population-Based Studies
Schulz and Rothwell
Stroke 2003;34:2050-2059.
ABSTRACT | FULL TEXT  

Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women's Health Initiative: A Randomized Trial
Wassertheil-Smoller et al.
JAMA 2003;289:2673-2684.
ABSTRACT | FULL TEXT  

References
Circulation 2002;106:3373-3421.
FULL TEXT  

Low Concentration of Serum Total Cholesterol Is Associated With Multifocal Signal Loss Lesions on Gradient-Echo Magnetic Resonance Imaging: Analysis of Risk Factors for Multifocal Signal Loss Lesions
Lee et al.
Stroke 2002;33:2845-2849.
ABSTRACT | FULL TEXT  

How Well Are Hypertension, Hyperlipidemia, Diabetes, and Smoking Managed After a Stroke or Transient Ischemic Attack?
Mouradian et al.
Stroke 2002;33:1656-1659.
ABSTRACT | FULL TEXT  

Smoking and gender
Bolego et al.
Cardiovasc Res 2002;53:568-576.
ABSTRACT | FULL TEXT  

Risk of Hospitalized Stroke in Men Enrolled in the Honolulu Heart Program and the Framingham Study: A Comparison of Incidence and Risk Factor Effects * Editorial Comment: A Comparison of Incidence and Risk Factor Effects
Rodriguez et al.
Stroke 2002;33:230-236.
ABSTRACT | FULL TEXT  

Are women more sensitive to smoking than men? Findings from the Renfrew and Paisley study
Marang-van de Mheen et al.
Int J Epidemiol 2001;30:787-792.
ABSTRACT | FULL TEXT  

Knowledge of Stroke Risk Factors, Warning Symptoms, and Treatment Among an Australian Urban Population
Sug Yoon et al.
Stroke 2001;32:1926-1930.
ABSTRACT | FULL TEXT  

Re: Anticardiolipin Antibodies Are Not an Independent Risk Factor for Stroke Response
Sargeant et al.
Stroke 2001;32 :1234-1237.
FULL TEXT  

Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association
Goldstein et al.
Circulation 2001;103:163-182.
FULL TEXT  

Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association
Goldstein et al.
Stroke 2001;32:280-299.
FULL TEXT  

Incidence and Risk Factors for Subtypes of Cerebral Infarction in a General Population : The Hisayama Study
Tanizaki et al.
Stroke 2000;31:2616-2622.
ABSTRACT | FULL TEXT  

Ischemic Stroke Risk With Oral Contraceptives: A Meta-analysis
Gillum et al.
JAMA 2000;284:72-78.
ABSTRACT | FULL TEXT  

Biobehavioral characteristics of nondemented older adults with subclinical brain atrophy
Swan et al.
Neurology 2000;54:2108-2114.
ABSTRACT | FULL TEXT  

Smoking and Atherosclerotic Cardiovascular Disease in Men With Low Levels of Serum Cholesterol: The Korea Medical Insurance Corporation Study
Jee et al.
JAMA 1999;282:2149-2155.
ABSTRACT | FULL TEXT  

Effects of Leisure-Time Physical Activity and Ventilatory Function on Risk for Stroke in Men: The Reykjavik Study
Agnarsson et al.
ANN INTERN MED 1999;130:987-990.
ABSTRACT | FULL TEXT  

Passive smoking as well as active smoking increases the risk of acute stroke
Bonita et al.
Tobacco Control 1999;8:156-160.
ABSTRACT | FULL TEXT  

Cigarette Smoking and Mortality Risk: Twenty-five-Year Follow-up of the Seven Countries Study
Jacobs et al.
Arch Intern Med 1999;159:733-740.
ABSTRACT | FULL TEXT  

Prevention of a First Stroke: A Review of Guidelines and a Multidisciplinary Consensus Statement From the National Stroke Association
Gorelick et al.
JAMA 1999;281:1112-1120.
ABSTRACT | FULL TEXT  

Nicotine Increases Plasminogen Activator Inhibitor-1 Production by Human Brain Endothelial Cells via Protein Kinase C–Associated Pathway • Editorial Comment
Zidovetzki et al.
Stroke 1999;30:651-655.
ABSTRACT | FULL TEXT  

Risk Factor Modification in Stroke Prevention : The Experience of a Stroke Clinic
Joseph et al.
Stroke 1999;30:16-20.
ABSTRACT | FULL TEXT  

Smoking and stroke: a causative role
Aldoori and Rahman
BMJ 1998;317:962-763.
FULL TEXT  

Hyperinsulinemia and the Risk of Stroke in Healthy Middle-Aged Men : The 22-Year Follow-Up Results of the Helsinki Policemen Study
Pyorala et al.
Stroke 1998;29:1860-1866.
ABSTRACT | FULL TEXT  

Mechanisms Underlying Cerebrovascular Effects of Cigarette Smoking in Rats In Vivo • Editorial Comment
Iida et al.
Stroke 1998;29:1656-1665.
ABSTRACT | FULL TEXT  

Risk Factors for Stroke and Type of Stroke in Persons With Isolated Systolic Hypertension
Davis et al.
Stroke 1998;29:1333-1340.
ABSTRACT | FULL TEXT  

Cerebral Vascular Accidents in Young Patients with Essential Thrombocythemia: Relation with Other Known Cardiovascular Risk Factors
Randi et al.
ANGIOLOGY 1998;49:477-481.
ABSTRACT  

Primary Prevention of Coronary Heart Disease: Guidance From Framingham : A Statement for Healthcare Professionals From the AHA Task Force on Risk Reduction
Grundy et al.
Circulation 1998;97:1876-1887.
FULL TEXT  

Cigarette Smoking as a Determinant of High-Grade Carotid Artery Stenosis in Hispanic, Black, and White Patients With Stroke or Transient Ischemic Attack
Mast et al.
Stroke 1998;29:908-912.
ABSTRACT | FULL TEXT  

Increased Oxygen Extraction Fraction Is Associated With Prior Ischemic Events in Patients With Carotid Occlusion
Derdeyn et al.
Stroke 1998;29:754-758.
ABSTRACT | FULL TEXT  

Guidelines for Carotid Endarterectomy : A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association
Biller et al.
Circulation 1998;97:501-509.
FULL TEXT  

Guidelines for Carotid Endarterectomy : A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association
Biller et al.
Stroke 1998;29:554-562.
FULL TEXT  

Risk Factors for Ischemic Stroke in a Russian Community : A Population-Based Case-Control Study
Feigin et al.
Stroke 1998;29:34-39.
ABSTRACT | FULL TEXT  

Early Health Effects of the Emerging Tobacco Epidemic in China: A 16-Year Prospective Study
Zheng-Ming et al.
JAMA 1997;278:1500-1504.
ABSTRACT  

Cardiovascular Disease in Women : A Statement for Healthcare Professionals From the American Heart Association
Mosca et al.
Circulation 1997;96:2468-2482.
FULL TEXT  

Trends in Stroke Incidence : The Copenhagen City Heart Study
Truelsen et al.
Stroke 1997;28:1903-1907.
ABSTRACT | FULL TEXT  

Risk Factors for Stroke Due to Cerebral Infarction in Young Adults
You et al.
Stroke 1997;28:1913-1918.
ABSTRACT | FULL TEXT  

Dose-Response Relationship Between Prevalence of Cerebrovascular Disease and Ingested Inorganic Arsenic
Chiou et al.
Stroke 1997;28:1717-1723.
ABSTRACT | FULL TEXT  

Risk Factors
Sacco et al.
Stroke 1997;28:1507-1517.
FULL TEXT  

A 15.5-Year Follow-up Study of Stroke in a Japanese Provincial City: The Shibata Study
Nakayama et al.
Stroke 1997;28:45-52.
ABSTRACT | FULL TEXT  

An Analysis of the Lowest Effective Intensity of Prophylactic Anticoagulation for Patients with Nonrheumatic Atrial Fibrillation
Hylek et al.
NEJM 1996;335:540-546.
ABSTRACT | FULL TEXT  

Morbidity and Mortality in Relation to Cigarette Smoking in Shanghai, China: A Prospective Male Cohort Study
Yuan et al.
JAMA 1996;275:1646-1650.
ABSTRACT  

Diabetes Mellitus as a Risk Factor for Death From Stroke : Prospective Study of the Middle-aged Finnish Population
Tuomilehto et al.
Stroke 1996;27:210-215.
ABSTRACT | FULL TEXT  

Predictors of Stroke in Middle-Aged Patients With Non–Insulin-Dependent Diabetes
Lehto et al.
Stroke 1996;27:63-68.
ABSTRACT | FULL TEXT  

Primary Prevention of Stroke
Bronner et al.
NEJM 1995;333:1392-1400.
FULL TEXT  

Management of Disorders of Cholesterol, Triglyceride, and Lipoprotein Metabolism: Report 6 of the Council on Scientific Affairs
Council on Scientific Affairs
Arch Fam Med 1995;4:869-878.
ABSTRACT  

Changes in the Sex Ratio of Stroke Mortality in the Period of 1955 Through 1990
Zhang et al.
Stroke 1995;26:1774-1780.
ABSTRACT | FULL TEXT  

Smoking Cessation and the Risk of Stroke in Middle-aged Men
Wannamethee et al.
JAMA 1995;274:155-160.
ABSTRACT  

The Geography of Stroke Mortality in the United States and the Concept of a Stroke Belt
Lanska and Kuller
Stroke 1995;26:1145-1149.
FULL TEXT  

Dietary Sodium, Potassium, Saturated Fat, Alcohol, and Stroke Mortality
Sasaki et al.
Stroke 1995;26:783-789.
ABSTRACT | FULL TEXT  

Do changes in cardiovascular risk factors explain changes in mortality from stroke in Finland?
Vartiainen et al.
BMJ 1995;310:901-904.
ABSTRACT | FULL TEXT  

Stroke Prevention
Gorelick
Arch Neurol 1995;52:347-355.
ABSTRACT  

The Impact of Alcohol and Hypertension on Stroke Incidence in a General Japanese Population : The Hisayama Study
Kiyohara et al.
Stroke 1995;26:368-372.
ABSTRACT | FULL TEXT  

Risk Factors for Ischemic Ocular Motor Nerve Palsies
Jacobson et al.
Arch Ophthalmol 1994;112:961-966.
ABSTRACT  

Smoking Cessation and Time Course of Decreased Risks of Coronary Heart Disease in Middle-Aged Women
Kawachi et al.
Arch Intern Med 1994;154:169-175.
ABSTRACT  

Risk Factors for Cerebrovascular Disease as Correlates of Cognitive Function in a Stroke-Free Cohort
Desmond et al.
Arch Neurol 1993;50:162-166.
ABSTRACT  

Smoking Cessation and Decreased Risk of Stroke in Women
Kawachi et al.
JAMA 1993;269:232-236.
ABSTRACT  

Cigarette Smoking: A Risk Factor for Cerebral Infarction in Young Adults
Love et al.
Arch Neurol 1990;47:693-698.
ABSTRACT  

The Prevalence of Cardiovascular Risk Factors Among Elderly Chinese Americans
Choi et al.
Arch Intern Med 1990;150:413-418.
ABSTRACT  

Cigarette Smoking: A Risk Factor for Hemorrhagic and Nonhemorrhagic Stroke
Gill et al.
Arch Intern Med 1989;149:2053-2057.
ABSTRACT  

Cigarette Smoking Cessation and Extracranial Carotid Atherosclerosis
Tell et al.
JAMA 1989;261:1178-1180.
ABSTRACT  

Cigarette Smoking as a Risk Factor in Stroke
Barrett-Connor
JAMA 1988;260:34-34.
ABSTRACT  

Cigarette Smoking as a Risk Factor in Stroke
Varma
JAMA 1988;260:34-34.
ABSTRACT  

CIGARETTE SMOKING IS A RISK FACTOR FOR STROKE
JWatch General 1988;1988:8-8.
FULL TEXT