Brief Answer:
well... statistics don't work that way

Detailed Answer:
The fundamental problem is that their are groupings for illnesses.
First, there are different sort of strokes. There are ones in which there is a blockage. These are associated with hypertension, cholesterol, and cigarettes. There are strokes due to a vessel blowing apart. These are not so associated with cigarettes in most people. Then there is when a piece of debris from a vessel lodges in the brain. This is generally associated with a particular problem like cancer or infection, or bad arteries in the neck or heart problems that are not very much associated with cigarettes at all.

Then there is the person. Some people have a very bad reaction to cigarettes and have a lot of vessel problems (Buer·ger's dis·ease). This is TOTALLY associated with cigarettes.

The risk is not going to be uniform. Some people are very susceptible and some are quite insensitive to vessel problems and cigarettes.

But, if I did know the answer... if you smoke ONE cigarette and your vessels in your fingers change color, if after one cigarette the time it takes for capillary return changes or if the fingers go white after one cigarete, you have a LOT of risk from even one cigarette. This is uncommon but not rare.

https://www.ncbi.nlm.nih.gov/pubmed/0000
smoking is estimated to be about 15 to 20% of the cause of stroke. You look at those who smoke and those who don't and see how many had stroke and you are able to estimate the amount of the smoking effect. These people on average soked 20 cigarettes a day. 1 cigarette is certainly a tenth of that so, that would be about 2 % of the risk. This cannot distinguish between 2% of the population that ONE CIGARETTE is like a gun to the head and 100% risk or if there is an even 17 percent increased risk in all 100% of smokers. The finger circulation test is a pretty good estimator of a particular person's risks.

BUT if the blood pressure wasn't even slightly treated prior to the stroke, that is considered a much higher risk factor.

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Brief Answer:
Very good information.

Detailed Answer:
Very helpful. Several points.
Ischemic strokes are characterized by being relatively small and in small vessels and often with OTHER small vessels having signs of blockages in other places. This implies that vessel damaging conditions are the cause:
hypertension being by far the most important, but also cholesterol and smoking and diabetes. And if there are other vessels with other blockages (small) then about a baseline of at least 10% risk per year. And those smoking like a chimney might have so much lung disease that they have huge work of breathing and are doing the equivalent of running marathons per day JUST TO BREATHE. They are thin, puff very hard, and have NO risk of diabetes and might not have enough fat to make a blockage. Aspirin cuts risk in half. Statins lower risk also and add to the aspirin risk. They seem to work even in those without elevated cholesterol leading people to think they lower the cholesterol getting into the vessels even if the cholesterol elsewhere is normal.

Risk is not VERY low. It's lower. With BP control and aspirin it certainly decreased more than 50% and likely 75% lower BUT still more than 1% risk per year. Cigarettes likely double the remaining risk to 2 to 3%. The fewer risks there are the more relative effect of the remaining ones.

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Brief Answer:
POSSIBLY lower.

Detailed Answer:
On this particular issue, the question is totally out with vaping. Cannot say.

There is much less stuff in vaping than in cigarettes so on questions of safety involving big bunches of chemicals producing big damage (lung destruction, cancer risk) then vaping is better. On changes in vessel tone and coagulability of clot forming things, nicotine by itself likely does significant effects and vaping may very well have risks. The overall exposure to nicotine might be anything when going from 3 cigarettes per day to vaping. The vaping could easily mean MORE stress on the vessels due to MORE nicotine being absorbed. Especially when the cigarette amount is low. The world health organization came out against vaping specifically due to stroke risk.

Mostly, the risk doesn't seem likely to be reduced for stroke

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Brief Answer:
Very good questions.

Detailed Answer:
ok, first, the cholesterol medicine lowers risk of stroke (ischemic stroke) EVEN with a normal cholesterol. Yeah, we don't know why either. Many stories have been made up about it.
On ideal blood pressure and stroke. It's a bit tricky. There's too much AND too little. Furthermore, it is highly likely that the numbers in the current recommendations are WRONG. Currently the recommendation is about 133/about 80 BUT you would get a different result depending on: 1) if someone is in the middle of a stroke--nobody lowers blood pressure rapidly during a stroke and we haven't for 50 years--rapid changes in blood pressure during a stroke make the stroke worse. 2) There can be changes in blood pressure from the brain reacting to lack of blood flow; tricky to know what to do during that but nothing too fast. 3) blood pressure medicines that give huge ups and down roller coasters are bad for you (you won't get those, so it's hardly even worth mentioning). 4) there's absolute numbers and relative numbers. I had someone whose blood pressure was 240/150. We didn't want to go to 120 / 80. about 150/100 seemed pretty good. a 20% decline is fine.

ooohhhhhhh
You're in a special group.

Women who were on birth control with smoking and overweight had a relatively high risk of stroke (any risk at age under 50 is quite noticeable). .... smoking is bad.....overweight is bad.....estrogen is bad. The PCOS, by definition, means SKY HIGH HORMONES...worse than with birth control pills. These are risk factors that can be eliminated. The theory is that the blood gets thick and triggers stroke. Birth control pills are totally ruled out for this population High estrogen makes the liver put out more stuff and thickens the blood. BUT in someone with PCOS the estrogen should go LOWER on birth control, the amount of the thick proteins should be LESS, and the risk of stroke should be LESS. Yeah, smoking has a very bad reputation in this particular context.

Metformin or weight loss (20%) stops PCOS.

So, all the meds are pretty close to perfect. Lisinopril is a perfect TYPE of blood pressure pill BUT it is relatively highly digested by the stomach. In some people. If it works fairly well with the blood pressure it is good. If the blood pressure bounces all over the place a simple change to a very similar RAMIPRIL Or quinipril or Benzipril will fix it up. If its 130 to 140.... personally, I wouldn't change it.
A blood thinner makes sense.
baby aspirin makes sense, a bit risky if coumadin is also used.
metformin makes sense .. it is a treatment for PCOS.

In heart disease, exercise trumps weight and the risk is lowered at least 50% by a mild amount of exercise and that is MUCH more doable than a 10-20% weight loss. In stroke, exercise benefits are SMALL. It's mainly being on blood pressure control and a bit on blood thinner/aspirin and also statins.

On your particular risk......See, this is wrong
http://www.cvriskcalculator.com/
it is heart disease AND/OR stroke and the risks are different for heart versus stroke. And you are in a funny group--high hormone women with stroke. The cigarettes are a notorious risk in this one group. I think the risk for stroke isn't as high as the calculator says BUT it IS much more tied to smoking in you than it would be in nearly any other group.

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Brief Answer:
maybe.

Detailed Answer:
Ok, there's a flawed thinking that doctors have where we are like cats with a laser pointer....we get distracted by bright objects in the foreground. So, when a few women (1 in 20,000) had strokes on birth control pills, we freaked. It was found that these women had other things in common. Weight and cigarettes. So, we pounced on the cofactors. You fit this pattern so we are going to be very upset about any cigarettes and the weight simply because women your age shouldn't be expected to have strokes.

Furthermore, if risks are overall low (1 in 20,000, seriously, that's the risk) we can identify a very rare occurence and if the people in this group mostly all smoke we can identify that as a risk. BUT identifying effects within this group is not possible because of the low risk we are talking about (do the people in this group have a 50% risk of second stroke if they don't do anything? do people in this group have no risk of a second stroke no matter what ?.... hard to say because there are so very few of you to follow for the years to see what happens and nobody is going to say to anybody in this group.. go ahead smoke all ya want).

So, yes, cigarettes seem like a huge risk in women with elevated hormones compared to other women in the same age group without any of the risks (where the stroke risk excluding meth/cocaine use is about zero). Risk of a second stroke? risk change with doing everything good or doing everything bad. Nope, cannot say.

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Brief Answer:
there is a larger issue here......

Detailed Answer:
The risk cannot be assessed due to the rarity of the condition. we cannot differentiate without doing an investigation whether the women with {high hormones + overweight + cigarette} who have an elevated risk of stroke (1 in 20,000) represent a UNIFORM risk for the group of 1 in 20,000 or popped up the one in 20,000 person who is 100% guaranteed that if they smoke one cigarette they are 100% guaranteed to have a stroke every time.

A real example. If someone stops XXXXXXX suddenly there is a 1 in 10,000 risk they will have a seizure. 1 in 10,000 people have a metabolism pathway for XXXXXXX in which they turn the drug into barbiturate...they get hooked on it and have withdrawal seizures from it. If you aren't that person, you don't metabolize it and you don't make barbiturate even if you take a whole bottle of XXXXXXX and cannot get hooked on it and cannot have withdrawal seizures. I had 2 patients try to kill themselves with XXXXXXX and merely had an overly long nap. I had one patient who took it for disk disease pain. Wasn't hooked on it. Got laid off from construction, stopped taking it and nearly had a seizure. The ER thought he had a psychotic break due to the shakes he was having. I gave him one XXXXXXX he got better, got discharged, we didn't think it was a good drug for him.

The larger issue is why you want to risk your life for one cigarette. Addiction much? It might be the nicotine, so replacement nicotine might be just as risky as the cigarettte. But good news. The nicotine in one cigarette is not much. It means it is a psychological addiction more than a nicotine dependency. See if other things substitute for nicotine (exercise, food, chocolate, coffee, etc).
Self aversion therapy: you run through the triggering circumstance for the craving but generate a bad feeling on top of it (thinking of how one felt with a stroke for example). Then, after 5 to 10 reps, the trigger also brings up bad feelings.

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