Smoker's paradox
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The smoker's paradox (or smoking paradox)[1] is a phenomenon where unexpected inverse correlations have been recorded between cigarette smoking and the incidence of certain diseases. Such correlations are considered paradoxical because of the overwhelmingly harmful health effects of tobacco.
Reports of smoker's paradox
On epidemiological grounds, unexpected correlations between smoking and favorable outcomes initially emerged in the context of Cardiovascular disease.[2] Tobacco smoke has many bioactive substances, including nicotine and carbon monoxide (see carbon monoxide-releasing molecules), capable of exerting a variety of systemic effects.[2] However, surprising correlations recorded may also stem from non-biological factors such as residual confounding (that is to say, the methodological difficulties in completely adjusting for every confounding factor that can affect outcomes in observational studies).[2] Systematic review of reports that suggested smokers respond better to treatment for ischemic stroke provided no support for claims of a smoker's paradox.[1] Other diseases in which claims have of a smoker's paradox have been made include Parkinson's disease,[2] basal-cell carcinoma,[3] malignant melanoma,[3] acute mountain sickness,[4] pemphigus,[5] celiac disease,[6] and Sjögren syndrome,[7][medical citation needed] and COVID-19.[2]
Parkinson's disease
In the case of Parkinson's disease, there has been longstanding interest among epidemiologists about the possible existence of a smoking paradox, prompted by a lengthy series of observational studies.[8] Non-biological factors that may contribute to an apparently substantial reduction in risk include reverse causality (whereby prodromal symptoms of Parkinson's disease may lead some smokers to quit before diagnosis), and personality considerations (since people predisposed to Parkinson's disease tend to be relatively risk-averse they may be less likely to have a history of smoking).[8] data-driven hypothesis that long-term ingestion of small amounts of nicotine in a form other than smoking might provide a degree of neurological protection against Parkinson's disease remains open as a potential preventive strategy.[8]
History
The term smoker's paradox was coined in 1995 in relation to reports that smokers appeared to have unexpectedly good short-term outcomes following acute coronary syndrome or stroke.[2] One of the first reports of an apparent smoker's paradox was published in 1968 based on an observation of relatively decreased mortality in smokers one month after experiencing acute myocardial infarction.[9] In the same year, a case–control study first suggested a possible protective role in Parkinson's disease.[8][10]
References
- ^ a b Li B, Li D, Liu JF, Wang L, Li BZ, Yan XJ, Liu W, Wu K, Xiang RL (2019). ""Smoking paradox" is not true in patients with ischemic stroke: a systematic review and meta-analysis". Journal of Neurology. doi:10.1007/s00415-019-09596-3. PMID 31664548.
- ^ a b c d e f Usman, Muhammad Shariq; Siddiqi, Tariq Jamal; Khan, Muhammad Shahzeb; Patel, Urvish K; Shahid, Izza; Ahmed, Jawad; Kalra, Ankur; Michos, Erin D (2020-08-11). "Is there a smoker's paradox in COVID-19?". BMJ Evidence-Based Medicine: bmjebm–2020–111492. doi:10.1136/bmjebm-2020-111492. ISSN 2515-446X. PMID 32788164.
- ^ a b Arafa, Ahmed; Mostafa, Alshimaa; Navarini, Alexander A.; Dong, Jia-Yi (2020). "The association between smoking and risk of skin cancer: a meta-analysis of cohort studies". Cancer Causes & Control. 31 (8): 787–794. doi:10.1007/s10552-020-01319-8. ISSN 1573-7225. PMID 32458137. S2CID 218898153.
- ^ Xu, Chen; Lu, Hong-Xiang; Wang, Yu-Xiao; Chen, Yu; Yang, Sheng-Hong; Luo, Yong-Jun (2016). "Association between smoking and the risk of acute mountain sickness: a meta-analysis of observational studies". Military Medical Research. 3: 37. doi:10.1186/s40779-016-0108-z. ISSN 2054-9369. PMC 5146861. PMID 27980800.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Lai, O.; Recke, A.; Zillikens, D.; Kasperkiewicz, M. (August 2018). "Influence of cigarette smoking on pemphigus - a systematic review and pooled analysis of the literature". Journal of the European Academy of Dermatology and Venereology. 32 (8): 1256–1262. doi:10.1111/jdv.14886. PMID 29478302. S2CID 3830347.
- ^ Wijarnpreecha, Karn; Lou, Susan; Panjawatanan, Panadeekarn; Cheungpasitporn, Wisit; Pungpapong, Surakit; Lukens, Frank J.; Ungprasert, Patompong (2018). "Cigarette smoking and risk of celiac disease: A systematic review and meta-analysis". United European Gastroenterology Journal. 6 (9): 1285–1293. doi:10.1177/2050640618786790. ISSN 2050-6406. PMC 6206527. PMID 30386601.
- ^ Stone, Donald U.; Fife, Dustin; Brown, Michael; Earley, Keith E.; Radfar, Lida; Kaufman, C. Erick; Lewis, David M.; Rhodus, Nelson L.; Segal, Barbara M.; Wallace, Daniel J.; Weisman, Michael H. (2017). "Effect of Tobacco Smoking on The Clinical, Histopathological, and Serological Manifestations of Sjögren's Syndrome". PLOS ONE. 12 (2): e0170249. Bibcode:2017PLoSO..1270249S. doi:10.1371/journal.pone.0170249. ISSN 1932-6203. PMC 5293551. PMID 28166540.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ a b c d Chen H (2018). "The Changing Landscape of Parkinson Epidemiologic Research". Journal of Parkinson's Disease. 8 (1): 1–12. doi:10.3233/JPD-171238. PMC 5836408. PMID 29154293.
- ^ Weinblatt, E; Shapiro, S; Frank, C W; Sager, R V (August 1968). "Prognosis of men after first myocardial infarction: mortality and first recurrence in relation to selected parameters". American Journal of Public Health and the Nations Health. 58 (8): 1329–1347. doi:10.2105/AJPH.58.8.1329. ISSN 0002-9572. PMC 1228764. PMID 5691369.
- ^ Nefzger MD, Quadfasel FA, Karl VC (1968). "A retrospective study of smoking in Parkinson's disease". American Journal of Epidemiology. 88 (2): 149–58. doi:10.1093/oxfordjournals.aje.a120874. PMID 5673487.