Risk Factors For Subarachnoid Hemorrhage Research Articles

Abstract TMP73: Incidence and Outcomes for Aneurysmal Subarachnoid Hemorrhage During Pregnancy: A 20-year Analysis of the National Inpatient Sample From 2000-2019

Introduction: Pregnancy is a risk factor for subarachnoid hemorrhage (SAH). Albeit rare, it can be a devastating condition with high rates of mortality and morbidity. We aim to better understand this risk and its impact on in-hospital outcomes over a longitudinal time period in a large population based sample. Methods: We analyzed the 2000-2019 National Inpatient Sample, selecting for aneurysmal SAH (aSAH). Pregnant patients were identified. Demographics, comorbidities, and outcomes were compared between pregnant and not pregnant groups. We used T-tests and chi-squared tests , and created a 1:1 propensity score matched cohort. Variables with notable differences (>0.1 standardized mean) were used for multivariable regression, determining adjusted odds ratios (AOR) and beta coefficients for the impact of pregnancy on outcomes. Results: Of the 662,981 SAH patients identified, 0.82% were pregnant. SAH incidence in these patients increased over our study period. Pregnant patients were more often African American (34.9% vs 15.2%) and were more likely to have Medicaid insurance (43.4% vs 12.5%). They had a lower Elixhauser Comorbidity Score (6.01 vs 8.52). They had less hydrocephalus (8.7% vs 23.0), coma (5.4% vs 11.5%), and ventilator use (16.3% vs 28.4%). However, they experienced seizures more often (18.1% vs 12.3). Their rate of in-hospital mortality was lower (7.3% vs 24.2%), and they were more frequently discharged to home or short term hospitals (72.9% vs 38.8%). After propensity matching, pregnant patients had a reduced risk of in-hospital mortality (AOR 0.47, p<0.001). They were also more likely to be discharged home or to short term hospital although these were not statistically significant to our pre-specified alpha. Conclusion: sSAH in pregnancy appears to be very rare and is associated with better outcome compared to the general population, as the majority of pregnant patients with aSAH present with favorable neurological status.

Therapeutic small molecules in the development of treatment for subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is a severe and often fatal condition characterized by the accumulation of blood beneath the arachnoid layer of the meninges. Predominantly affecting individuals in the 40–60 age range, it is commonly caused by head trauma from falls or car accidents. Ruptures of cerebral aneurysms also contribute significantly to SAH. Risk factors for SAH include hypertension and smoking, and symptoms typically include severe headache and neck pain. Diagnosing SAH typically involves a combination of medical history, physical examination, and imaging studies such as computed tomography angiography or magnetic resonance imaging angiography. Recent research suggests that pharmaceutical management of intracerebral hemorrhage (ICH) includes the administration of recombinant activated factor VII, tranexamic acid, and aggressive blood pressure reduction. For patients with significant SAH and ICH, minimally invasive surgical procedures for hematoma evacuation, as well as surgical evacuation of SAH and ICH, have proven to be highly beneficial. Furthermore, an emerging area of treatment involves therapeutic small molecules designed to interrupt the pathophysiological pathways leading to SAH. This novel approach holds promise for advancing our understanding and management of this complex medical condition.

Risk of Cerebral Aneurysm Rupture After Liver Transplantation: Development and Validation of a Hemorrhagic Stroke Scoring Model.

Liver transplantation (LT) patients appear to be more prone to neurological events compared to individuals undergoing other types of solid-organ transplantation. The aims of the present study were to analyze the prevalence of unruptured intracranial aneurysms (UIAs) in patients undergoing liver transplantation (LT) and to examine the perioperative occurrence of subarachnoid hemorrhage (SAH). Also, it intended to systematically identify the risk factors of SAH and hemorrhagic stroke (HS) within a year after LT and to develop a scoring system which involves distinct clinical features of LT patients. Patients who underwent LT from January 2012 to March 2022 were analyzed. All included patients underwent neurovascular imaging within 6 months before LT. We conducted an analysis of prevalence and radiological features of UIA and SAH. The clinical factors that may have an impact on HS within one year of LT were also reviewed. Total of 3,487 patients were enrolled in our study after applying inclusion and exclusion criteria. The prevalence of UIA was 5.4%. The incidence of SAH and HS within one year following LT was 0.5% and 1.6%, respectively. We developed a scoring system based on multivariable analysis to predict the HS within 1-year after LT. The variables were a poor admission mental status, the diagnosis of UIA, serum ammonia levels, and Model for End-stage Liver Disease (MELD) scores. Our model showed good discrimination among the development (C index, 0.727; 95% confidence interval [CI], 0.635-0.820) and validation (C index, 0.719; 95% CI, 0.598-0.801) cohorts. The incidence of UIA and SAH was very low in LT patients. A poor admission mental status, diagnosis of UIA, serum ammonia levels, and MELD scores were significantly associated with the risk of HS within one year after LT. Our scoring system showed a good discrimination to predict the HS in LT patients.

Effect of Smoking Cessation on the Risk of Subarachnoid Hemorrhage: A Nested Case-Control Study in Korean Men.

Smoking is a well-established risk factor for subarachnoid hemorrhage (SAH), and current smokers have an increased risk of SAH. However, there are insufficient data on whether smoking cessation in current smokers reduces the risk of SAH. A nested case-control study was conducted based on the National Health Insurance Service-National Health Screening Cohort, which comprises nationwide health claims data and a national health screening program in Korea (2002-2019). We constructed a cohort of current male smokers without a history of stroke at the baseline health screening (2002-2003). From this cohort, cases were defined as individuals who experienced a nontraumatic SAH during the follow-up period up to 2019. Five controls were matched to each case using incidence density sampling. Smoking status (continuation or cessation) before the occurrence of SAH was evaluated using the repeated national health screening program. We conducted a multivariable conditional logistic regression analysis, adjusting for alcohol consumption, physical activity, body mass index, systolic blood pressure, and fasting blood glucose levels, to evaluate the association between SAH risk and smoking cessation. At baseline, there were 112 142 current male smokers. After excluding individuals with prior stroke or insufficient data, the cohort consisted of 105 223 eligible participants (mean age, 50.3±8.5 years). Among them, we identified 318 cases of SAH and 1590 matched controls. Those who quit smoking had a significantly lower risk of SAH compared with current smokers (adjusted odds ratio, 0.55 [95% CI, 0.41-0.73]). The risk of SAH decreased with a longer period of smoking cessation. The risk reduction with smoking cessation was consistent even among prior heavy smokers. Smoking cessation in current male smokers reduced the risk of SAH, and the risk reduction was greater as the cessation period increased. These findings warrant intensive efforts to encourage smokers, even heavy smokers, to quit.

Risk of subarachnoid haemorrhage reduces with blood pressure values below hypertensive thresholds.

Hypertension is a known risk factor for subarachnoid haemorrhage (SAH). The aim of this study was to describe the relationship between blood pressure and SAH using a large cohort study and perform a meta-analysis of the published literature. Participants in the UK Biobank were followed up via electronic records until 31 March 2017. Cox proportional hazards models were used to analyse the association between baseline blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP] and MABP [mean arterial blood pressure]) and subsequent aneurysmal SAH. Linearity was assessed by comparing models including and excluding cubic splines. Electronic databases were searched from inception until 11 February 2022 for studies reporting on blood pressure and SAH. A total of 500,598 individuals were included with 539 (0.001%) suffering from aneurysmal SAH. Nonlinear models including cubic splines visually appeared linear between SBP of 110 and 180 mmHg and there was minimal difference in fit between linear and nonlinear models. When values were stratified, those with SBP 120-130 mmHg were at higher risk compared to those with SBP <120 mmHg (hazard ratio [HR] 1.41 [1.02, 1.95]). The meta-analysis demonstrated a similar increased risk of SAH in individuals with SBP 120-130 mmHg relative to those with <120 mmHg (HR 1.41 [1.17, 1.72]). A stepwise increase in risk was also seen at each subsequent threshold (130-140 mmHg: HR 1.85 [1.53, 2.24], 140-160 mmHg: HR 2.16 [1.57, 2.98], 160-180 mmHg: HR 2.81 [1.85, 4.29], >180 mmHg: HR 5.84 [1.94, 17.54]). The rate of SAH increases linearly with higher SBP in the general population and specifically appears lower in those with SBP <120 mmHg.

The frequency and impact of tramadol addiction on acute aneurysmal subarachnoid hemorrhage: cross-sectional multicenter study

BackgroundArterial hypertension, cigarette smoking, excessive alcohol abuse and drug addiction such as cocaine all are known risk factors for aneurysmal subarachnoid hemorrhage (SAH). However, there is little information on whether tramadol addiction should also be considered as a risk factor for SAH. The purpose of this study was to investigate the prevalence and the impact of tramadol addiction on the symptomatology of intracranial aneurysmal SAH. We recruited 237 cases with acute aneurysmal ASH with a mean age of 52.3 ± 11.8 ranging from 17 to 86 years old.ResultsThere were 124 males and 113 females; 43 cases had a history of tramadol addiction (18.1%). Tramadol addicts were significantly younger, more likely to be male (97.7%), and more commonly associated with seizure onset compared with non-addicts. Multiple aneurysms, wide neck, and sizable aneurysms were significantly more common in tramadol than non-tramadol addicts as were dissecting aneurysms. There is a high association of acute aneurysmal SAH with tramadol addiction, especially in young patients.ConclusionsTramadol addiction might be regarded as modifiable risk factor of aneurysmal ASH and tramadol addicts had a worse presentation than non-tramadol addicts. If this finding is proved, it will be of great importance in managing patients with ruptured and un-ruptured intracranial aneurysms. Tramadol is available over-counter in some countries, more studies are needed.

Knowledge Mapping of Intracranial Aneurysm Clipping: A Bibliometric and Visualized Study (2001–2021)

Intracranial aneurysms (IAs) are common cerebrovascular diseases with high rates of mortality and disability. With the development of endovascular treatment technologies, the treatment of intracranial aneurysms has gradually turned to endovascular treatment. However, due to the complex disease characteristics and technical challenges of intracranial aneurysm treatment, surgical clipping still plays an important role. However, there is no summary of the research status and future trends in IA clipping. Publications related to IA clipping from 2001 to 2021 were retrieved from the Web of Science Core Collection (WoSCC) database. We conducted a bibliometric analysis and visualized study with the help of VOSviewer software and R program. We included 4104 articles from 90 countries. The volume of publications on IA clipping has generally increased. The United States, Japan and China were the countries that contributed the most. The University of California, San Francisco, Mayo Clinic, and the Barrow Neurological Institute are the main research institutions. World Neurosurgery and the Journal of Neurosurgery were the most popular journal and the most co-cited journal, respectively. These publications come from 12,506 authors among which Lawton MT, Spetzler RF, and Hernesniemi J published the most papers. Studies from the past 21 years on IA clipping can generally be divided into five parts: (1) the characteristics and technical difficulties of IA clipping; (2) perioperative management and imaging evaluation of IA clipping; (3) risk factors for subarachnoid hemorrhage caused by rupture of IA clippings; (4) outcomes, prognosis, and related clinical trials of IA clipping; and (5) endovascular management for IA clipping. "Occlusion," "experience," "internal carotid-artery," "intracranial anurysms," "management," and "subarachnoid hemorrhage" are the major keywords for future research hotspots. This bibliometric study clarified the global research status of IA clipping between 2001 and 2021. The United States contributed the most publications and citations, and World Neurosurgery and Journal of Neurosurgery can be considered landmark journals in this field. Studies regarding occlusion, experience, management, and subarachnoid hemorrhage will be the next research hotspots related to IA clipping in the future.

Analysis of risk factors for subarachnoid hemorrhage after mechanical thrombectomy in acute ischemic stroke with middle cerebral artery occlusion.

Analysis of risk factors for subarachnoid hemorrhage after mechanical thrombectomy in acute ischemic stroke with middle cerebral artery occlusion.

Use of antihypertensive medication and formation of de novo intracranial aneurysms.

Hypertension is a risk factor for subarachnoid hemorrhage and is also considered a risk factor for saccular intracranial aneurysm (sIA) formation. However, there is little direct evidence that antihypertensive medication will reduce sIA formation. The impact of antihypertensive medication on de novo sIA formation was studied in an angiographically followed cohort of 1419 patients. Patients were identified from our population-based Kuopio Intracranial Aneurysm Database, and data on the purchases of antihypertensive medication were obtained from a national registry. Univariate and multivariate analyses were used to investigate the risk factors. Of the 966 sIA patients who were prescribed with antihypertensive medication, 841 patients used the medication regularly; 20 of them had de novo sIA. One hundred and twenty-five patients used the medication irregularly and 12 of them developed de novo sIAs. Four hundred and fifty-three patients did not use antihypertensive medication even though 27 of them had a diagnosis of hypertension, and 10 of them developed de novo sIAs. In the multivariate analysis antihypertensive medication did not significantly reduce de novo sIA formation (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.84-3.06). Age at primary diagnosis (HR: 0.95, 95%: CI 0.93-0.98) and smoking history (HR: 5.53, 95% CI: 2.77-11.05) were significant risk factors for de novo sIA formation. Also, irregular usage of antihypertensive medication was a significant risk factor (HR: 3.84, 95% CI: 1.59-9.29) for de novo sIA formation. Antihypertensive agents were not associated with a reduction of de novo sIA formation, but irregular use of antihypertensive agents was associated with an increased risk of de novo sIA formation.

Cancer Related Subarachnoid Hemorrhage: A Multicenter Retrospective Study Using Propensity Score Matching Analysis.

ObjectiveTo investigate the clinical features, risk factors and underlying pathogenesis of cancer related subarachnoid hemorrhage (SAH).MethodsClinical data of SAH in patients with active cancer from January 2010 to December 2020 at four centers were retrospectively reviewed. Patients with active cancer without SAH were matched to SAH patients with active cancer group. Logistic regression was applied to investigate the independent risk factors of SAH in patients with active cancer, after a 1:1 propensity score matching (PSM). A receiver operator characteristic curve was configured to calculate the optimal cut-off value of the joint predictive factor for cancer related SAH.ResultsA total of 82 SAH patients with active cancer and 309 patients with active cancer alone were included. Most SAH patients with cancer had poor outcomes, with 30-day mortality of 41.5%, and with 90-day mortality of 52.0%. The PSM yielded 75 pairs of study participants. Logistic regression revealed that a decrease in platelet and prolonged prothrombin time were the independent risk factors of cancer related SAH. In addition, receiver operator characteristic curve of the joint predictive factor showed the largest AUC of 0.8131, with cut-off value equaling to 11.719, with a sensitivity of 65.3% and specificity of 89.3%.ConclusionPatients with cancer related SAH often have poor outcomes. The decrease in platelet and prolonged prothrombin time are the independent risk factors of cancer related SAH, and the joint predictive factor with cutoff value equal to 11.719 should hence serve as a novel biomarker of cancer related SAH.

Contemporary view on subarachnoidal hemorrhage: literature review

Subarachnoid hemorrhage is a severe, life-threatening variant of hemorrhagic stroke. It happens due to the blood release into the subarachnoid space and requires emergency medical care. This review contains data on modern epidemiology, morphology and pathophysiology, clinical presentation and peculiarities of diagnostics and treatment of subarachnoid hemorrhage. It covers key studies of Russian and foreign scientific groups on the causes and risk factors of subarachnoid hemorrhage and mechanisms of cerebral vasospasm development. Main professional scales used in daily clinical practice are mentioned. The sensitivity and specificity of the existing methods of unruptured aneurysms neuroimaging and subarachnoid hemorrhage are analyzed. Also, the article includes summarized information on existing and prospective options for nonsurgical and surgical treatment.

Analysis of Risk Factors Related to Acute Subarachnoid Hemorrhage After Spinal Surgery

Subarachnoid hemorrhage (SAH) is a rare complication secondary to cerebrospinal fluid (CSF) leakage during spinal surgery, but the specific cause of bleeding is still unclear. In this retrospective single-center study, we studied cases of acute SAH after spinal surgery to identify the related risk factors for bleeding. A total of 441 patients with CSF leakage who underwent spinal surgery from 2011 to 2020 were retrospectively analyzed. According to whether postoperative SAH occurred, the patients were divided into the SAH group and the control group. By comparing the demographic data, past history, imaging data, intraoperative findings, perioperative complications, and treatment conditions in the 2 groups to identify the risk factors for SAH, we aimed to provide guidance for the prevention of SAH after spinal surgery. In our study, the incidence of CSF during spinal surgery is 3.04%, and the rate for SAH associated with spine operation is 0.16%. In the SAH group, 17 patients (73.9%) had preoperative hypertension, and 3 patients (13.0%) had diabetes. The intraoperative CSF leakage was approximately 118.4 ± 56.9 mL. The mean postoperative drainage was 15.4 ± 5.8 mL/hour. Compared with the SAH group, the control group had 123 patients (29.4%) with hypertension before the operation and 40 patients (9.6%) with diabetes. The intraoperative CSF leakage was approximately 76.3 ± 23.0 mL, and the mean postoperative continuous drainage was 9.7 ± 2.1 mL/hour. Binary logistic regression analysis showed that hypertension, intraoperative CSF leakage, and postoperative CSF continuous drainage speed were related to SAH. The rapid leakage of CSF caused by rupture of the dural sac during surgery and the rapid drainage of CSF after surgery were closely related to the occurrence of SAH. In addition, hypertension was a factor related to SAH during spinal surgery.

Diabetes is not protective against the formation of unruptured cerebral aneurysm

ObjectivesDiabetes appears to decrease the risk of subarachnoid hemorrhage. However, it is not clear whether diabetes decreases the risk of aneurysm formation. The aim of our study to evaluate the risk of unruptured cerebral aneurysm in patients with diabetes mellitus. MethodsWe used data from participants who underwent brain magnetic resonance angiography (MRA) and laboratory tests at the Healthcare System Gangnam Center of Seoul National University Hospital between January 2010 and December 2013. From the 17,368 participants who underwent brain MRA, we analyzed 16,337 subjects whose diabetes status could be identified. ResultsThe number of participants with diabetes was 2299 (14.1%). The proportion of participants with cerebral aneurysms was 2.3% in the diabetic group and 2.7% in the non-diabetic group, which was not significantly different (P = 0.225). There were no significant differences in the size, location, and multiplicity of aneurysms between the diabetes and control groups. In multivariate logistic regression, older age showed significant risk effects on cerebral aneurysms, but female sex, hypertension, diabetes, obesity, and smoking did not show significant risk effects. ConclusionIn this study, diabetes did not affect the risk of cerebral aneurysm formation. In addition, neither smoking, nor hypertension was a significant risk factor for unruptured cerebral aneurysms. The lack of association between cerebral aneurysm and the traditional risk factors for subarachnoid hemorrhage requires further study. Risk factors for cerebral aneurysm development and those for cerebral aneurysm rupture may be different.

Subarachnoid haemorrhage. A critical neurosurgical emergency

Subarachnoid haemorrhage (SAH) accounts for 3% of all strokes and is the cause of 5% of stroke mortality. SAH by rupture of cerebral aneurysm or arterial-venous malformation (AVM) remains the most devastating cerebrovascular disease. During admission for SAH, about 30-70% of patients suffer a rebleed, and from all rebleeds, about 90% lead to death no matter the treatment. Available current scales help predict the prognosis and guide the therapy. Considering that the lifestyle risk factors for SAH are of increasing prevalence, it is expected that it will affect even more people in the future. SAH should not be regarded as a disease but rather a set of events with devastating complications requiring adequate management from debut extending long after patient discharge.

Rupture Risk of Intracranial Aneurysm and Prediction of Hemorrhagic Stroke after Liver Transplant.

Postoperative hemorrhagic stroke (HS) is a rare yet devastating complication after liver transplantation (LT). Unruptured intracranial aneurysm (UIA) may contribute to HS; however, related data are limited. We investigated UIA prevalence and aneurysmal subarachnoid hemorrhage (SAH) and HS incidence post-LT. We identified risk factors for 1-year HS and constructed a prediction model. This study included 3544 patients who underwent LT from January 2008 to February 2019. Primary outcomes were incidence of SAH, HS, and mortality within 1-year post-LT. Propensity score matching (PSM) analysis and Cox proportional hazard analysis were performed. The prevalence of UIAs was 4.63% (n = 164; 95% confidence interval (CI), 3.95–5.39%). The 1-year SAH incidence was 0.68% (95% CI, 0.02–3.79%) in patients with UIA. SAH and HS incidence and mortality were not different between those with and without UIA before and after PSM. Cirrhosis severity, thrombocytopenia, inflammation, and history of SAH were identified as risk factors for 1-year HS. UIA presence was not a risk factor for SAH, HS, or mortality in cirrhotic patients post-LT. Given the fatal impact of HS, a simple scoring system was constructed to predict 1-year HS risk. These results enable clinical risk stratification of LT recipients with UIA and help assess perioperative HS risk before LT.

Smoking Causes Fatal Subarachnoid Hemorrhage

One of the largest twin studies to date suggested that subarachnoid hemorrhage (SAH) is mainly of nongenetic origin, but the causal effect of environmental factors on SAH is yet unknown. We hypothesized that if only one of the twins experience fatal SAH, they do not share the most important environmental risk factor for SAH, namely smoking. If true, such finding would suggest that smoking causes SAH. Through the nationwide cause-of-death register, we followed 16 282 same-sex twin pairs of Finnish origin from the older Finnish Twin Cohort between 1976 and 2018 and identified all participants who died from SAH. For the baseline, we collected risk factor information about smoking, hypertension, physical activity, body mass index, alcohol consumption, and education. We classified the pairs as monozygotic, dizygotic, or of unknown zygosity. We examined the within-pair risk factor differences in the pairs discordant for SAH, that is, where one twin died from SAH and the other did not. We computed both individual (whole cohort) and pairwise (discordant pair) hazard ratios and 95% CIs. During the 869 469 person-years of follow-up, we identified 116 discordant and 2 concordant (both died from SAH) twin pairs for fatal SAH. Overall, 25 of the discordant twin pairs were monozygotic. For the whole cohort, smoking (occasional/current) was associated with increased risk of SAH death (hazard ratio, 3.33 [CI, 2.24-4.95]) as compared with nonsmokers (never/former). In the pairwise analyses for discordant twin pairs, we found that the twin who smoked had an increased risk of fatal SAH (hazard ratio, 6.33 [CI, 1.87-21.4]) as compared with the nonsmoking twin. The association remained consistent regardless of the twin pairs' zygosity or sex. Our results provide strong evidence for a causal, rather than associative, role of smoking in SAH.

Smoking status and unruptured intracranial aneurysm among brain health check-up examinees: a cross-sectional study in Japan.

Objective: Although it is well known that smoking is a risk factor for subarachnoid hemorrhage, the association between smoking and unruptured intracranial aneurysms remains unclear. The aim of the present study was to investigate whether smoking status was associated with unruptured intracranial aneurysms among Japanese brain health check-up examinees.Materials and Methods: We conducted a cross-sectional study of 1,496 adults (aged 26–90 years) undergoing brain health check-ups at a single community medical support hospital in Akita, Japan between 2009 and 2013. In Japan, people can discretionarily undergo a brain health check-up for early detection of unruptured intracranial aneurysms or subarachnoid hemorrhages. Participants responded to a questionnaire on lifestyle, such as smoking status, and were classified into three groups: never, former, and current smoker. The evaluation of unruptured intracranial aneurysms detected by magnetic resonance angiography was performed by an expert physician. Multiple logistic regression models were used to estimate the odds ratio for unruptured intracranial aneurysms. We performed statistical analyses by age, sex, and family history of stroke.Results: The number of participants with unruptured intracranial aneurysms was 43 (2.9%). The mean age (standard deviation) and proportion of males was 55.8 (9.5) years and 53.3%, respectively. The adjusted odds ratios (95% confidence intervals) for unruptured intracranial aneurysms of 1.21 (0.48–3.08) among former smokers and 2.88 (1.10–7.50) among current smokers were compared to those of never smokers (p-trend = 0.041). After stratifying by age, sex, and family history of stroke, no interactions were found.Conclusion: This cross-sectional study conducted in Japan showed that smoking was positively associated with unruptured intracranial aneurysms among brain health check-up examinees.

Abdominal Aortic Aneurysm is an Independent Risk Factor for Subarachnoid Hemorrhage

Abstract INTRODUCTION Though both diseases share similar risk factors, little is known about the relationship between intracranial aneurysms (IA) and abdominal aortic aneurysms (AAA). Previous studies have described an increased incidence of IA in patients with AAA, though the rate of subarachnoid hemorrhage (SAH) in patients with AAA has not been described. This study evaluated the rate of SAH in patients with known AAA. METHODS We examined longitudinally linked medical claims data from a large private insurer, finding rates aneurysmal subarachnoid hemorrhage (aSAH) and secured aneurysmal SAH (saSAH) in 2004 to 2014 among patients with previously diagnosed AAA. RESULTS We identified 62 910 patients with a diagnosis of AAA with a total of 193 009 yr of at risk coverage, and compared them to age- and sex-matched controls matched 5:1. Both populations were predominantly male (70.9%) with an average age of 70.8. Rates of hypertension (69.7% vs 50.6%, P &lt; .0001) and smoking (12.8% vs 4.1%, P &lt; .0001) were higher in the AAA group compared to controls. A total of 50 admissions for aSAH were identified in AAA patients (26/100K patient years, 95% CI 19-44) and 115 admissions for aSAH in controls (7/100K patient years, 95% CI 6-9), giving an incidence rate ratio (IRR) of 3.6 (95% CI 2.6-5.0, P &lt; .0001) and a comorbidity-adjusted IRR of 2.8 (95% CI 1.9-3.9) for AAA patients. The incidence of saSAH was proportionally even higher in AAA patients than controls, 7 vs 2/100K patient years, IRR 4.5 (95% CI 3.2-6.3, P &lt; .0001). CONCLUSION The rate of SAH is elevated in patients with AAA compared with age- and sex-matched controls, even after adjustment for comorbidities. Use of AAA in screening criteria for IA should be considered.

Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950000 adults.

Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium. We obtained individual participant data of 949683 persons (330334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries. During 13704959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100000 person-years] in men and 13.8 [(11.4-16.2)/100000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH. The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

Physical activity associates with subarachnoid hemorrhage risk\u2013 a population-based long-term cohort study

Benefit of physical activity in prevention of aneurysmal subarachnoid hemorrhage (SAH) is unclear. We aimed to clarify this by studying how different types of physical activity associate with SAH risk. By following 65 521 population-based FINRISK participants prospectively from medical and autopsy registries since 1972 until 2014, we detected 543 incident SAHs. At baseline, we measured leisure-time physical activity (LTPA), occupational physical activity (OPA), and commuting physical activity (CPA) levels. The Cox model adjusted for all well-known SAH risk factors and for socioeconomic status, provided hazard ratios (HRs) for physical activity variables. Every 30-minute increase in weekly LTPA decreased SAH risk linearly in men and women HR = 0.95 (95% CI = 0.90–1.00). CPA reduced SAH risk as well, but the association diminished as participants retired. In contrast, individuals with moderate (1.41, 1.04–1.92) and high OPA (1.34, 0.99–1.81) had elevated SAH risk. Protective association of LTPA persisted in all age and hypertension groups, and was even greater in current smokers 0.88 (0.81–0.96) than non-smokers (p = 0.04 for difference). Commuting and leisure time physical activity seem to reduce SAH risk in men and women and is most beneficial for smokers. Future intervention studies should investigate whether physical activity can reduce the rupture risk of intracranial aneurysms.