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Cigarette Smoking: Modifiable Risk Factor for MS
Q) What impact does cigarette smoking have on multiple sclerosis?
The development and disease course of multiple sclerosis (MS) are influenced by a variety of factors. Some—such as genetics, environmental exposure to viruses, and place of residence at an early age—cannot be modified. There are, however, other factors that can be modified, one of which is cigarette smoking.
Between 15% and 17% of patients with MS smoke cigarettes, a rate comparable to that of the general United States population; among US veterans with MS, prevalence can reach as high as 28.5%.1-4 Factors that correlate with smoking in patients with MS include younger age, lower economic/educational background, being single, and lack of available or affordable cessation strategies.1,2,4
Studies have found that in addition to contributing to the development of diseases (eg, cardiovascular and pulmonary) and certain cancers, smoking cigarettes may put individuals at higher risk for MS.5-7 Data also show that increased duration of smoking and/or increased quantity of cigarettes smoked may exacerbate this risk.5 While the mechanisms are not well understood, there appears to be a higher prevalence of MS in male smokers and in current smokers (compared with those who have already quit).6 Other studies have also suggested an increased risk with passive exposure to cigarette smoke.6,7
Current cigarette smoking accelerates the conversion from a relapsing to a progressive form of MS.8-11 One study demonstrated that after the diagnosis of MS had been made, continued smoking increased the rate of acceleration to a progressive form by 5% per year.9 Current smokers also had a higher disability rate attributable to their MS, but smoking cessation may improve disability outcomes.9-11
Current smokers, with or without other risk factors, therefore have incentive to quit smoking to reduce risk for MS. Patients with MS who smoke should be counseled on the increased risk associated with the combination of passive smoke exposure and other genetic and environmental factors, which may increase risk for MS in first-degree family members.3
While there is no one-size-fits-all strategy for smoking cessation in patients with MS, traditional behavioral and/or medication therapies should be offered. Some factors involved in cigarette smoking are variable and difficult to address, in addition to the physical dependence on nicotine. Many patients will require interventions to address related poor health behaviors (eg, lack of exercise) and comorbid factors (eg, depression).5,7 —BW
Bryan Walker, MHS, PA-C
Department of Neurology, Division of MS and Neuroimmunology, Duke University Medical Center, Durham, North Carolina
1. Friend KB, Mernoff ST, Block P, Reeve G. Smoking rates and smoking cessation among individuals with multiple sclerosis. Disabil Rehabil. 2006;28(18):1135-1141.
2. Marrie R, Horwitz R, Cutter G, et al. High frequency of adverse health behaviors in multiple sclerosis. Mult Scler. 2009;15(1): 105-113.
3. CDC. Current cigarette smoking among adults in the United States. www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking. Accessed January 13, 2017.
4. Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services. Arch Phys Med Rehabil. 2007;88(11):1394-1399.
5. Ascherio A, Munger K. Epidemiology of multiple sclerosis: from risk factors to prevention—an update. Semin Neurol. 2016; 36(2):103-114.
6. Zhang P, Wang R, Li Z, et al. The risk of smoking on multiple sclerosis: a meta-analysis based on 20,626 cases from case-control and cohort studies. PeerJ. 2016;4:e1797.
7. Hedström AK, Olsson T, Alfredsson L. Smoking is a major preventable risk factor for multiple sclerosis. Mult Scler. 2016; 22(8):1021-1026.
8. Healy BC, Ali EN, Guttmann CR, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66(7):858-864.
9. Goldman MD, Stüve O. Smoking beyond multiple sclerosis diagnosis: a risk factor still worth modifying. JAMA Neurol. 2015;72(10):1105-1106.
10. Ramanujam R, Hedström A, Manouchehrinia A, et al. Effect of smoking cessation on multiple sclerosis prognosis. JAMA Neurol. 2015;72(10):1117-1123.
11. Ben-Zacharia A. The effect of modifiable risk factors on multiple sclerosis progression. Neurology. 2016;86(16):Supplement P1.387.
Clinician Reviews in partnership with
MS Consult is edited by Colleen J. Harris, MN, NP, MSCN, Nurse Practitioner/Manager of the Multiple Sclerosis Clinic at Foothills Medical Centre in Calgary, Alberta, Canada, and Bryan Walker, MHS, PA-C, who is in the Department of Neurology, Division of MS and Neuroimmunology, at Duke University Medical Center in Durham, North Carolina. This month’s responses were authored by Bryan Walker and Lisa Marie Fox, MSPAS, PA-C, who is in the Division of Multiple Sclerosis, Department of Neurology, at Johns Hopkins Hospital in Baltimore.
Clinician Reviews in partnership with
MS Consult is edited by Colleen J. Harris, MN, NP, MSCN, Nurse Practitioner/Manager of the Multiple Sclerosis Clinic at Foothills Medical Centre in Calgary, Alberta, Canada, and Bryan Walker, MHS, PA-C, who is in the Department of Neurology, Division of MS and Neuroimmunology, at Duke University Medical Center in Durham, North Carolina. This month’s responses were authored by Bryan Walker and Lisa Marie Fox, MSPAS, PA-C, who is in the Division of Multiple Sclerosis, Department of Neurology, at Johns Hopkins Hospital in Baltimore.
Clinician Reviews in partnership with
MS Consult is edited by Colleen J. Harris, MN, NP, MSCN, Nurse Practitioner/Manager of the Multiple Sclerosis Clinic at Foothills Medical Centre in Calgary, Alberta, Canada, and Bryan Walker, MHS, PA-C, who is in the Department of Neurology, Division of MS and Neuroimmunology, at Duke University Medical Center in Durham, North Carolina. This month’s responses were authored by Bryan Walker and Lisa Marie Fox, MSPAS, PA-C, who is in the Division of Multiple Sclerosis, Department of Neurology, at Johns Hopkins Hospital in Baltimore.
Q) What impact does cigarette smoking have on multiple sclerosis?
The development and disease course of multiple sclerosis (MS) are influenced by a variety of factors. Some—such as genetics, environmental exposure to viruses, and place of residence at an early age—cannot be modified. There are, however, other factors that can be modified, one of which is cigarette smoking.
Between 15% and 17% of patients with MS smoke cigarettes, a rate comparable to that of the general United States population; among US veterans with MS, prevalence can reach as high as 28.5%.1-4 Factors that correlate with smoking in patients with MS include younger age, lower economic/educational background, being single, and lack of available or affordable cessation strategies.1,2,4
Studies have found that in addition to contributing to the development of diseases (eg, cardiovascular and pulmonary) and certain cancers, smoking cigarettes may put individuals at higher risk for MS.5-7 Data also show that increased duration of smoking and/or increased quantity of cigarettes smoked may exacerbate this risk.5 While the mechanisms are not well understood, there appears to be a higher prevalence of MS in male smokers and in current smokers (compared with those who have already quit).6 Other studies have also suggested an increased risk with passive exposure to cigarette smoke.6,7
Current cigarette smoking accelerates the conversion from a relapsing to a progressive form of MS.8-11 One study demonstrated that after the diagnosis of MS had been made, continued smoking increased the rate of acceleration to a progressive form by 5% per year.9 Current smokers also had a higher disability rate attributable to their MS, but smoking cessation may improve disability outcomes.9-11
Current smokers, with or without other risk factors, therefore have incentive to quit smoking to reduce risk for MS. Patients with MS who smoke should be counseled on the increased risk associated with the combination of passive smoke exposure and other genetic and environmental factors, which may increase risk for MS in first-degree family members.3
While there is no one-size-fits-all strategy for smoking cessation in patients with MS, traditional behavioral and/or medication therapies should be offered. Some factors involved in cigarette smoking are variable and difficult to address, in addition to the physical dependence on nicotine. Many patients will require interventions to address related poor health behaviors (eg, lack of exercise) and comorbid factors (eg, depression).5,7 —BW
Bryan Walker, MHS, PA-C
Department of Neurology, Division of MS and Neuroimmunology, Duke University Medical Center, Durham, North Carolina
Q) What impact does cigarette smoking have on multiple sclerosis?
The development and disease course of multiple sclerosis (MS) are influenced by a variety of factors. Some—such as genetics, environmental exposure to viruses, and place of residence at an early age—cannot be modified. There are, however, other factors that can be modified, one of which is cigarette smoking.
Between 15% and 17% of patients with MS smoke cigarettes, a rate comparable to that of the general United States population; among US veterans with MS, prevalence can reach as high as 28.5%.1-4 Factors that correlate with smoking in patients with MS include younger age, lower economic/educational background, being single, and lack of available or affordable cessation strategies.1,2,4
Studies have found that in addition to contributing to the development of diseases (eg, cardiovascular and pulmonary) and certain cancers, smoking cigarettes may put individuals at higher risk for MS.5-7 Data also show that increased duration of smoking and/or increased quantity of cigarettes smoked may exacerbate this risk.5 While the mechanisms are not well understood, there appears to be a higher prevalence of MS in male smokers and in current smokers (compared with those who have already quit).6 Other studies have also suggested an increased risk with passive exposure to cigarette smoke.6,7
Current cigarette smoking accelerates the conversion from a relapsing to a progressive form of MS.8-11 One study demonstrated that after the diagnosis of MS had been made, continued smoking increased the rate of acceleration to a progressive form by 5% per year.9 Current smokers also had a higher disability rate attributable to their MS, but smoking cessation may improve disability outcomes.9-11
Current smokers, with or without other risk factors, therefore have incentive to quit smoking to reduce risk for MS. Patients with MS who smoke should be counseled on the increased risk associated with the combination of passive smoke exposure and other genetic and environmental factors, which may increase risk for MS in first-degree family members.3
While there is no one-size-fits-all strategy for smoking cessation in patients with MS, traditional behavioral and/or medication therapies should be offered. Some factors involved in cigarette smoking are variable and difficult to address, in addition to the physical dependence on nicotine. Many patients will require interventions to address related poor health behaviors (eg, lack of exercise) and comorbid factors (eg, depression).5,7 —BW
Bryan Walker, MHS, PA-C
Department of Neurology, Division of MS and Neuroimmunology, Duke University Medical Center, Durham, North Carolina
1. Friend KB, Mernoff ST, Block P, Reeve G. Smoking rates and smoking cessation among individuals with multiple sclerosis. Disabil Rehabil. 2006;28(18):1135-1141.
2. Marrie R, Horwitz R, Cutter G, et al. High frequency of adverse health behaviors in multiple sclerosis. Mult Scler. 2009;15(1): 105-113.
3. CDC. Current cigarette smoking among adults in the United States. www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking. Accessed January 13, 2017.
4. Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services. Arch Phys Med Rehabil. 2007;88(11):1394-1399.
5. Ascherio A, Munger K. Epidemiology of multiple sclerosis: from risk factors to prevention—an update. Semin Neurol. 2016; 36(2):103-114.
6. Zhang P, Wang R, Li Z, et al. The risk of smoking on multiple sclerosis: a meta-analysis based on 20,626 cases from case-control and cohort studies. PeerJ. 2016;4:e1797.
7. Hedström AK, Olsson T, Alfredsson L. Smoking is a major preventable risk factor for multiple sclerosis. Mult Scler. 2016; 22(8):1021-1026.
8. Healy BC, Ali EN, Guttmann CR, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66(7):858-864.
9. Goldman MD, Stüve O. Smoking beyond multiple sclerosis diagnosis: a risk factor still worth modifying. JAMA Neurol. 2015;72(10):1105-1106.
10. Ramanujam R, Hedström A, Manouchehrinia A, et al. Effect of smoking cessation on multiple sclerosis prognosis. JAMA Neurol. 2015;72(10):1117-1123.
11. Ben-Zacharia A. The effect of modifiable risk factors on multiple sclerosis progression. Neurology. 2016;86(16):Supplement P1.387.
1. Friend KB, Mernoff ST, Block P, Reeve G. Smoking rates and smoking cessation among individuals with multiple sclerosis. Disabil Rehabil. 2006;28(18):1135-1141.
2. Marrie R, Horwitz R, Cutter G, et al. High frequency of adverse health behaviors in multiple sclerosis. Mult Scler. 2009;15(1): 105-113.
3. CDC. Current cigarette smoking among adults in the United States. www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking. Accessed January 13, 2017.
4. Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services. Arch Phys Med Rehabil. 2007;88(11):1394-1399.
5. Ascherio A, Munger K. Epidemiology of multiple sclerosis: from risk factors to prevention—an update. Semin Neurol. 2016; 36(2):103-114.
6. Zhang P, Wang R, Li Z, et al. The risk of smoking on multiple sclerosis: a meta-analysis based on 20,626 cases from case-control and cohort studies. PeerJ. 2016;4:e1797.
7. Hedström AK, Olsson T, Alfredsson L. Smoking is a major preventable risk factor for multiple sclerosis. Mult Scler. 2016; 22(8):1021-1026.
8. Healy BC, Ali EN, Guttmann CR, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66(7):858-864.
9. Goldman MD, Stüve O. Smoking beyond multiple sclerosis diagnosis: a risk factor still worth modifying. JAMA Neurol. 2015;72(10):1105-1106.
10. Ramanujam R, Hedström A, Manouchehrinia A, et al. Effect of smoking cessation on multiple sclerosis prognosis. JAMA Neurol. 2015;72(10):1117-1123.
11. Ben-Zacharia A. The effect of modifiable risk factors on multiple sclerosis progression. Neurology. 2016;86(16):Supplement P1.387.