Stroke and tobacco: why quitting smoking can truly change what comes next

When a stroke occurs, its causes are often multiple. However, tobacco plays a major role that is still too frequently minimized. According to estimates, between 18 and 35% of strokes are directly linked to smoking. This significant figure highlights how deeply cigarettes affect blood vessels… and the brain.

Tobacco contains many toxic substances, such as carbon monoxide. These substances damage the vessel walls, making them stiffer and more fragile. At the same time, smoking thickens the blood, promotes clot formation and increases platelet aggregation. As a result, blood flow to the brain becomes more difficult, and the risk of thrombosis increases.

Tobacco also promotes atherosclerosis, meaning the buildup of fatty and calcium plaques in the arteries, which reduces their diameter and flexibility. Added to this are vascular spasms, partly related to the increase in blood pressure caused by nicotine.

Finally, when smoking, carbon monoxide replaces oxygen in the blood. The brain, an organ extremely sensitive to oxygen deprivation, is therefore less well supplied. All of these mechanisms together significantly increase the risk of stroke or transient ischemic attack (TIA).

Most importantly, they continue to act after a first stroke, exposing the patient to a high risk of worsening or recurrence if smoking continues.

Quitting smoking after a stroke: rapid… and lasting benefits

The good news is that the benefits of quitting smoking appear very quickly, even after a stroke.

Within the first hours after quitting, oxygen once again circulates properly to the cells. Vascular spasms decrease rapidly: every cigarette avoided is one less assault on the arteries.

Other benefits take longer to appear, but they are very real. A reduction in the risk of thrombosis, gradual improvement in arterial health, and a slowing of atherosclerosis can be observed over several weeks or months.

But the key message is clear: it is never too late to quit, and every smoke-free day counts in reducing the risk of recurrence.

Smoking less or switching products: a false good idea?

After a stroke, some patients consider “smoking less” or turning to other products. However, these strategies are rarely effective… and sometimes misleading.

Reducing tobacco consumption is only truly beneficial if the reduction is massive, by at least 80%. In practice, going from 20 or 30 cigarettes per day to one or two is extremely difficult to sustain over time. And even at low doses, each cigarette triggers vascular spasms, which remains dangerous after a stroke.

As for alternatives:

• Heated tobacco is not authorized in Belgium.
• Electronic cigarettes, although less harmful than traditional cigarettes in some respects (notably due to the absence of carbon monoxide), are not harmless. Their effects on blood circulation are still not fully understood and they are not recommended in this context.

Methods that have proven effective remain nicotine replacement therapies (patches, lozenges, gums) and certain medications, prescribed and monitored by trained professionals such as tobacco specialists.

Stress, weight gain, discouragement: separating fact from fiction

After a stroke, misconceptions about smoking are common — and understandable.

Many patients feel that smoking helps them cope with stress. In reality, tobacco is a false friend: nicotine increases stress hormones. What is perceived as relaxation is often simply the temporary relief of withdrawal-related stress. Learning to breathe deeply, allowing oneself moments of calm, or finding other ways to take a break can restore these sensations… without the risks.

Another common concern is weight gain. This is indeed possible, and not only due to snacking. Tobacco increases energy expenditure: a smoker burns around 300 calories per day when smoking 20 cigarettes. When quitting, metabolism changes. However, specialized support often makes it possible to limit or even avoid weight gain.

Finally, some believe that quitting “is no longer useful” after a stroke. This is false. The benefits of quitting are clearly demonstrated scientifically, particularly in reducing the risk of recurrence and improving quality of life.

The key role of family and healthcare professionals in smoking cessation

Quitting smoking is a personal journey, but no one should have to walk it alone.

The role of relatives

Loved ones can play a decisive role, provided they avoid guilt-inducing attitudes, which are often counterproductive. Expressing concern with kindness, supporting without lecturing, encouraging without forcing: the goal is to strengthen the person’s motivation and autonomy. Change must come from within.

The role of healthcare professionals

All healthcare professionals (neurologists, nurses, physiotherapists, occupational therapists) involved in stroke follow-up can help raise awareness, notably through motivational interviewing. They can all serve as essential relays. General practitioners and tobacco specialists are trained to support patients in quitting.

Providing information without judgment, using a motivational approach, and offering support adapted to the patient’s life context: these simple actions have a real impact on the success of smoking cessation.

It should be noted that some alternative methods, such as laser treatment, are not part of scientific recommendations and have no proven effectiveness. They therefore cannot be endorsed in a hospital setting.

Conclusion

After a stroke, quitting smoking is not just a recommendation: it is a real opportunity to protect the future. With appropriate support, guidance and information, this goal is achievable — at any age and at any stage of the care pathway.