The “smoker's paradox” in cardiovascular diseases: A review of the arguments for and against

The authors analyze the literature regarding the “smoker's paradox” and its potential mechanisms. The “smoker's paradox” involves the better prognosis for smokers hospitalized for cardiovascular causes when compared with non-smokers. It was first described in patients treated with thrombolysis due to coronary incidents, and was later observed in patients hospitalized for stroke. In this paper, the authors present a review of the literature available on the subject, particularly in the context of its pathogenesis and possible clinical implications. So far, however, the arguments against the very existence of the “smoker's paradox” appear to be the stronger. Many circumstances imply that perhaps the phenomenon is a result of sample selection, the younger age of onset of cardiovascular illness in smokers or fewer comorbidities.