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Smoker's paradox

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In epidemiology, 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, that are capable of exerting a variety of systemic effects.[2] Surprising correlations 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 exist of a smoker's paradox include Parkinson's disease,[2] basal-cell carcinoma,[3] malignant melanoma,[3] acute mountain sickness,[4] pemphigus,[5] celiac disease,[6] Sjögren syndrome,[7][medical citation needed], schizophrenia,[8] and COVID-19.[2]

In 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 that consistently suggested a possibly substantial reduction in risk.[9][10][11][12] Non-biological factors that may contribute to such observations include reverse causality (whereby prodromal symptoms of Parkinson's disease may lead some smokers to quit before diagnosis), and personality considerations (people predisposed to Parkinson's disease tend to be relatively risk-averse, and may be less likely to have a history of smoking).[9] Possible existence of a biological effect is supported by a few studies that involved low levels of exposure to nicotine without any active smoking.[9] A data-driven hypothesis that long-term administration of low doses of nicotine might provide a degree of neurological protection against Parkinson's disease remains open as a potential preventive strategy.[9][13][14][15]

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.[16] In the same year, a case–control study first suggested a possible protective role in Parkinson's disease.[9][17]

References

  1. ^ 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.
  2. ^ 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.
  3. ^ 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.
  4. ^ 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)
  5. ^ 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.
  6. ^ 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.
  7. ^ 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)
  8. ^ Sagud M, Mihaljevic Peles A, Pivac N (September 2019). "Smoking in schizophrenia: recent findings about an old problem". Current Opinion in Psychiatry. 32 (5): 402–408. doi:10.1097/YCO.0000000000000529. PMID 31135490.
  9. ^ a b c d e 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.
  10. ^ Kouli A, Torsney KM, Kuan WL (2018). "Parkinson's Disease: Etiology, Neuropathology, and Pathogenesis". In Stoker TB, Greenland JC (eds.). Parkinson's Disease: Pathogenesis and Clinical Aspects [Internet]. Brisbane: Codon publications. doi:10.15586/codonpublications.parkinsonsdisease.2018. PMID 30702842.
  11. ^ Martino R, Candundo H, Lieshout PV, Shin S, Crispo JA, Barakat-Haddad C (2017). "Onset and progression factors in Parkinson's disease: a systematic review". Neurotoxicology. 61: 132–141. doi:10.1016/j.neuro.2016.04.003. PMID 27058967.
  12. ^ Breckenridge CB, Berry C, Chang ET, Sielken RL, Mandel JS (2016). "Association between Parkinson's Disease and cigarette smoking, rural living, well-water consumption, farming and pesticide use: systematic review and meta-analysis". Plos One. 11 (4): e0151841. doi:10.1371/journal.pone.0151841. PMC 4824443. PMID 27055126.
  13. ^ Ascherio A, Schwarzschild MA (November 2016). "The epidemiology of Parkinson's disease: risk factors and prevention". The Lancet. Neurology. 15 (12): 1257–1272. doi:10.1016/S1474-4422(16)30230-7. PMID 27751556.
  14. ^ Oertel W, Schulz JB (October 2016). "Current and experimental treatments of Parkinson disease: A guide for neuroscientists". Journal of Neurochemistry. 139 Suppl 1: 325–337. doi:10.1111/jnc.13750. PMID 27577098.
  15. ^ Ma C, Liu Y, Neumann S, Gao X (2017). "Nicotine from cigarette smoking and diet and Parkinson disease: a review". Translational Neurodegeneration. 6: 18. doi:10.1186/s40035-017-0090-8. PMC 5494127. PMID 28680589.
  16. ^ 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.
  17. ^ 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.
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