To the Editor.
—We were extremely interested to read the important article by Kawachi et al,1 in which they demonstrated that after smoking cessation the risk of stroke was decreased among female nurses. We think it is important to emphasize that nursing is a more stressful job than most other female professions. The possibility exists that a stress-induced, acute increase in blood pressure may also be an important factor in predisposition to hemorrhagic stroke (rather than the smoking-induced rise in blood pressure).As Kawachi et al note, "too few cases of stroke (n=2) occurred among current users of oral contraceptives to permit meaningful analysis." Because the age range of the nurses in this study was 30 to 55 years and because use of contraceptive pills is contraindicated in smokers older than 30 years of age and in nonsmokers older than 35 years of age, one would expect that currently
Gocze PM, Laszik Z. Smoking Cessation and Risk of Stroke in Women. JAMA. 1993;269(17):2213–2214. doi:10.1001/jama.1993.03500170043028
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