New research published in Global Heart (the journal of the World Heart Federation) shows that deaths from ischaemic stroke (IS) due to tobacco use in China, India, and Russia together are higher than the total for all the world's other countries combined. The research is by Dr Derrick Bennett, Nuffield Department of Population Health, University of Oxford, UK, and colleagues.
The research looks at the results relating to IS in the global burden of disease (GBD) study published in 2012, but also provides additional analysis on the effects of tobacco consumption, an important modifiable risk factor for IS. In both 1990 and 2010, the top ranked countries for IS deaths that could be attributed to tobacco consumption were China, Russia, and India. Dr Bennett says: "Tobacco control policies that target both smoking initiation and smoking cessation can play an important role in the prevention of IS. In China, Russia, and India, even modest reductions in the number of current smokers could see millions of lives saved due to prevention of IS alone."
Of all the deaths from IS attributed to tobacco consumption in 187 countries included in the GBD 2010 study, in 1990, China accounted for 26%, Russia for 10%, India for 7%, the United States for 5%, and Japan for 4%. In 2010, the countries with the most IS deaths attributable to tobacco were China (29%, 155,332 deaths), Russia (12%, 62 110 deaths), India (11%, 56 670 deaths), while all other countries saw 48.5% of all IS deaths due to smoking (258 084), see figure 2 of full paper). Dr Bennett adds: "Worryingly, the estimated IS deaths attributable to tobacco consumption in China, Russia, and India had increased in the 20-year period. Even though the United States and Japan had improved between 1990 and 2010, they were still ranked sixth and fifth in 2010, with 2.6% and 3.4% of all IS deaths attributable to tobacco consumption." The United Kingdom was in 18th position in 2010, with an estimated 5515 deaths from IS due to tobacco smoking, while Canada in was in 41st position with 1634 deaths and Australia 56th position with 845 deaths.
Dr Bennett underlines the major importance of tobacco smoking as a risk factor for stroke, highlighting a recent study by Peters et al. showing that the risk for IS was around 50% higher in smokers (men and women ) versus non-smokers. He also noted that there is reliable large-scale evidence on the benefits of quitting available in both men and women. He concludes: "Meaningful implementation of the WHO Framework Convention on Tobacco Control (FCTC) is a top priority not only for reducing IS burden but also the burden from other chronic non-communicable diseases."