Cigarette Crackdown in|Finland Reduces Strokes

(CN) — A new study finds that Finland's national fight against smoking is radically reducing the most fatal form of stroke.

The findings, which were published Friday in the journal Neurology, focused on a potential connection between decreased smoking rates and the occurrence of subarachnoid hemorrhage, the most fatal form of stroke in Finnish people under the age of 50.

Finland's public health campaign and laws limiting the sale of cigarettes and areas where smoking is allowed have drastically reduced the number of Finnish people who use tobacco.

"Even though we cannot demonstrate a direct causation in nationwide studies, it is highly likely that the national tobacco policies in Finland have contributed to the decline in the incidence of this type of severe brain hemorrhage," said Jaakko Kaprio, who co-authored the study.

The study examined the changes in the incidence of severe brain hemorrhage with changes in the prevalence of smoking between 1998 — when the Finnish government began campaigning against tobacco use — and 2012.

During that period, the prevalence of severe brain hemorrhage decreased by 45 percent among women and 38 percent among men under the age of 50. In the same time frame, the occurrence of severe brain hemorrhage decreased by 16 percent among women and 26 percent among men over 50.

The smoking rate of Finns aged 15 to 64 decreased by 30 percent between 1998 and 2012.

"It is extraordinary for the incidence of any cardiovascular disease to decrease so rapidly at the population level in such a short time," Kaprio said.

Strokes can lead to permanent disability in adults, including paralysis in one or more parts of the body, difficulty communicating and trouble reading or writing.

About 1,000 Finns suffer severe brain hemorrhage annually, most of whom are adults of working age. Nearly half of these individuals die within a year.

Subarachnoid hemorrhage is generally caused by a ruptured cerebral aneurysm. Smoking is a key risk factor for severe brain hemorrhage.

Cerebral aneurysms are more common in people over the age of 70 — more than 10 percent of individuals in this age group have them — but they generally do not rupture.

"Previous studies have indicated that smoking is one of the most important susceptibility factors for rupturing aneurysms, so in that sense the now-established connection between a decrease in smoking and a decrease in subarachnoid hemorrhage is not surprising," said lead author Miikka Korja.

However, Korja also pointed out that the incidence rate of severe brain hemorrhages is largely unknown since most patients who immediately die of a hemorrhage outside of a hospital are often mistakenly classified as having died from heart failure. In Finland, autopsies are conducted in most situations where a death occurs outside of a hospital in order to confirm the cause of death.

"According to the research, approximately one-fourth of people with subarachnoid hemorrhages have died outside of hospital or in the emergency room. All Nordic countries include deaths outside of hospitals in their incidence statistics for subarachnoid hemorrhage, and have reached largely similar estimates," Korja said.

"Nevertheless, assumptions of an extraordinarily high prevalence of subarachnoid hemorrhages in Finland have been repeatedly stated, even in top medical journals, leading Finnish subarachnoid hemorrhage and aneurysm studies being disregarded in general surveys and recommendations. However, research does not back this assumption."

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