To the Editor.
—The study by Kawachi et al1 provides support for the promotion of smoking cessation and for counseling young people to refrain from smoking in the first place.Tables 3 and 4 appear to show a protective effect of an earlier age at starting to smoke and the risk of subarachnoid hemorrhage. This trend does not seem to be addressed by the authors. Perhaps the ischemic stroke—causing mechanisms associated with smoking that were postulated by the authors might tend to increase the risk of ischemic stroke while decreasing the risk of hemorrhagic stroke.
Chin DL. Smoking Cessation and Risk of Stroke in Women. JAMA. 1993;269(17):2213. doi:10.1001/jama.1993.03500170043027