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January 10, 2026Journal of Clinical MedicineOpen Access

Stroke Incidence and Smoking in American Indians: An Update from the Strong Heart Study

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Key result

Current smoking linked to ~123% greater stroke risk vs nonsmokers among American Indians.

Why the study?

To investigate the relationship between cigarette smoking and long-term stroke outcomes in American Indian participants of the Strong Heart Study.

Does cigarette smoking increase the risk of incident stroke in American Indians?

Population

5802 American Indian participants without prevalent stroke

Comparison

Baseline smoking status compared to nonsmokers and former smokers

Design

Longitudinal, population-based cohort study

Follow-up

Pooled median 19.54 years (range, 0.02–32.62)

Authors

TNTaylor NiznikUniversity of Oklahoma Health Sciences CenterJRJessica ReeseGeneral / Preventive / LipidsJDJason F. DeenPediatric Cardiology

Discussion

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Implication

Supports cessation efforts in American Indians; confirms prior associations and extends evidence to this population.

Key Points

  • This research examines how cigarette smoking impacts long-term stroke outcomes among American Indians in the Strong Heart Study.
  • Conducted a longitudinal, population-based cohort study across multiple American Indian tribes.
  • Included 5802 participants without a prior stroke, monitored from 1989 to 2021.
  • Calculated stroke incidence rates and performed shared frailty Cox proportional hazards models for analysis.
  • Among participants, 38.3% were current smokers at baseline.
  • Incident stroke occurred in 7.9% of participants during a median follow-up of 19.54 years.
  • Current smokers had a 2.23-fold higher risk of stroke compared to nonsmokers and a 1.69-fold higher risk compared to former smokers.

Structured PICO

Does cigarette smoking increase the risk of incident stroke in American Indians?

P
Population
5,802 American Indian participants without prevalent stroke from tribes and communities in Oklahoma, Arizona, and the Dakotas.
I
Intervention
Current cigarette smoking at baseline
C
Comparator
Nonsmokers and former smokers
O
Outcome
Incident strokehard clinical

Current smoking significantly increases the long-term risk of incident stroke in American Indians compared to both never and former smokers, highlighting the critical need for culturally tailored smoking cessation interventions.

Cite This Study

Niznik et al. (2026) studied this question. Current smokers had a 2.23-fold higher risk of incident stroke compared to nonsmokers (HR = 2.23, 95% CI = 1.73–2.88) among American Indians.

synapsesocial.com/papers/696321d091e05aa366cb8111https://doi.org/10.3390/jcm15020431

Topics

Heart failureHFrEF treatmentSGLT2 inhibitors in heart failureHFpEF management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Stroke Incidence and Survival in American Indians, Blacks, and Whites: The Strong Heart Study and Atherosclerosis Risk in Communities Study2019 · 26 citations
  2. 2Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study2010 · 22 citations
  3. 3Hypertension in Adult American Indians1996 · 96 citations
  4. 4Stroke Risk Factors, Genetics, and Prevention2017 · 1,987 citations
  5. 5Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-20122014 · 1,602 citations