Smoking, atrial fibrillation, and ischemic stroke: a confluence of epidemics

PURPOSE OF REVIEW: Smoking and atrial fibrillation are major contemporary health concerns. They commonly coexist and are frequent causes of ischemic stroke. The purpose of this article is to describe recent scientific investigations about smoking, atrial fibrillation, and ischemic stroke, with a primary focus on prevention.

RECENT FINDINGS: Smoking predisposes to atrial fibrillation and is useful for the prediction of future atrial fibrillation. Several recent risk prediction models for adverse events associated with atrial fibrillation include smoking as a component. Smoking status identifies patients at high risk of incident atrial fibrillation, adverse events in an emergency ward after admission with atrial fibrillation, thromboembolic events following a diagnosis of atrial fibrillation, and potentially poor control of vitamin K antagonist treatment.

SUMMARY: From multiple perspectives of atrial fibrillation, patients who smoke represent a high-risk population. Appropriate preventive measures targeting this endangered population are paramount. These include smoking cessation, appropriate care in the emergency ward, and careful selection of the optimal antithrombotic strategy to reduce the major burden of ischemic stroke attributed to the confluence of the epidemics of smoking and atrial fibrillation.