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Ishita Roy

People Who Began Smoking Before 20 Face Higher Stroke Risk, Study Shows

<span>Smoking</span> has long been recognized as one of the most preventable causes of disease and early death worldwide. It plays a major role in heart attacks, strokes and several chronic illnesses. While public health messaging often focuses on how much a person smokes, new research suggests that when someone starts smoking may be just as important for long-term health.

A large nationwide study published in Scientific Reports analyzed health data from over nine million adults in South Korea. The findings were striking. People who began smoking before the age of 20 faced a significantly higher risk of stroke, heart attack and early death compared to those who started later, even if their total lifetime smoking exposure was similar.

<h2><span rel="noindex">Smoking Before 20</span>: Why the age matters</h2>

Traditionally, doctors and researchers estimate smoking-related harm using pack-years, which combines the number of cigarettes smoked per day with the number of years a person has smoked. While this remains useful, the new study highlights an important gap. Two people with the same pack-years may not have the same health risks if one started smoking much earlier in life.

The researchers found that early starters had a much higher risk of stroke and heart attack than those who took up smoking after the age of 20. This suggests that the body may be especially vulnerable to tobacco damage during adolescence and early adulthood, making age of initiation an independent risk factor.

<h2>Smoking and stroke: what we already know</h2>

The link between smoking and stroke is well established. Long-term studies, including the famous Framingham Heart Study, have consistently shown that smokers are far more likely to experience a stroke than non-smokers. The risk increases with the number of cigarettes smoked and affects people across age groups.

Smoking damages blood vessels, speeds up plaque build-up in arteries, raises blood pressure and makes blood more likely to clot. All of these changes increase the chances of both ischaemic and haemorrhagic strokes. Younger adults who smoke are not protected simply because of their age, and in many cases, their relative risk is even higher.

<h2>Key findings from the Korean cohort</h2>

The study followed participants for nearly nine years using data from a mandatory national health screening programme. Researchers looked at stroke, heart attack, combined cardiovascular events and overall death rates.

Those who started smoking before 20 had about a 78 percent higher risk of stroke compared to non-smokers, especially when they also had high smoking exposure. Early starters also showed a much greater risk of heart attacks and combined cardiovascular events. Importantly, they had a higher risk of death from all causes, not just heart-related conditions. These patterns were consistent across men and women and across different metabolic health profiles.

<h2>Why early smoking causes greater harm</h2>

There are several reasons why smoking at a younger age may be more damaging. During adolescence, the heart, blood vessels and brain are still developing, which may make them more sensitive to toxins in tobacco smoke. Starting early is also linked to stronger nicotine dependence, making quitting harder and often leading to longer periods of smoking.

Early exposure may also trigger lasting inflammatory and metabolic changes in the body. These changes can increase <span>stroke risk</span> later in life, even when total cigarette exposure appears similar on paper.

<h2>What this means for public health</h2>

The findings send a clear message. Preventing smoking during adolescence could significantly reduce the future burden of stroke and heart disease. School-based education, strong warning messages and policies that limit youth access to tobacco remain critical.

Delaying smoking initiation, even by a few years, may have lifelong benefits. With cardiovascular diseases already among the leading causes of death globally, protecting young people from tobacco use is not just about avoiding addiction. It is about safeguarding their long-term health.

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Smoking has long been recognized as one of the most preventable causes of disease and early death worldwide. It plays a major role in heart attacks, strokes and several chronic illnesses. While public health messaging often focuses on how much a person smokes, new research suggests that when someone starts smoking may be just as important for long-term health.A large nationwide study published in Scientific Reports analyzed health data from over nine million adults in South Korea. The findings were striking. People who began smoking before the age of 20 faced a significantly higher risk of stroke, heart attack and early death compared to those who started later, even if their total lifetime smoking exposure was similar.Smoking Before 20: Why the age mattersTraditionally, doctors and researchers estimate smoking-related harm using pack-years, which combines the number of cigarettes smoked per day with the number of years a person has smoked. While this remains useful, the new study highlights an important gap. Two people with the same pack-years may not have the same health risks if one started smoking much earlier in life.The researchers found that early starters had a much higher risk of stroke and heart attack than those who took up smoking after the age of 20. This suggests that the body may be especially vulnerable to tobacco damage during adolescence and early adulthood, making age of initiation an independent risk factor.Smoking and stroke: what we already knowThe link between smoking and stroke is well established. Long-term studies, including the famous Framingham Heart Study, have consistently shown that smokers are far more likely to experience a stroke than non-smokers. The risk increases with the number of cigarettes smoked and affects people across age groups.Smoking damages blood vessels, speeds up plaque build-up in arteries, raises blood pressure and makes blood more likely to clot. All of these changes increase the chances of both ischaemic and haemorrhagic strokes. Younger adults who smoke are not protected simply because of their age, and in many cases, their relative risk is even higher.Key findings from the Korean cohortThe study followed participants for nearly nine years using data from a mandatory national health screening programme. Researchers looked at stroke, heart attack, combined cardiovascular events and overall death rates.Those who started smoking before 20 had about a 78 percent higher risk of stroke compared to non-smokers, especially when they also had high smoking exposure. Early starters also showed a much greater risk of heart attacks and combined cardiovascular events. Importantly, they had a higher risk of death from all causes, not just heart-related conditions. These patterns were consistent across men and women and across different metabolic health profiles.Why early smoking causes greater harmThere are several reasons why smoking at a younger age may be more damaging. During adolescence, the heart, blood vessels and brain are still developing, which may make them more sensitive to toxins in tobacco smoke. Starting early is also linked to stronger nicotine dependence, making quitting harder and often leading to longer periods of smoking.Early exposure may also trigger lasting inflammatory and metabolic changes in the body. These changes can increase stroke risk later in life, even when total cigarette exposure appears similar on paper.What this means for public healthThe findings send a clear message. Preventing smoking during adolescence could significantly reduce the future burden of stroke and heart disease. School-based education, strong warning messages and policies that limit youth access to tobacco remain critical.Delaying smoking initiation, even by a few years, may have lifelong benefits. With cardiovascular diseases already among the leading causes of death globally, protecting young people from tobacco use is not just about avoiding addiction. It is about safeguarding their long-term health.

people who began smoking before 20 face higher stroke risk, study shows

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