Cigarette smoking and the development and rupture of cerebral aneurysms in a mixed race population: implications for population screening and smoking cessation

E. Sander Connolly, Alexander Poisik, Christopher J. Winfree, Louis J. Kim, Judy Huang, Donald J. McMahon, Robert A. Solomon

Research output: Contribution to journalArticle

Abstract

Background: Despite advances in the treatment of aneurysmal subarachnoid hemorhage (aSAH), major additional reductions in morbidity will require the identifications of unruptured aneurysms with a high propensity for bleeding. As screening the entire population is currently not cost-effective, risk factors for the presence of unruptured aneurysms must be identified, and if possible, these risk factors should be modified to reduce disease prevalence. Methods: To examine whether cigarette smoking independent of arterial hypertension is a risk factor for the development of cerebral aneurysms rather than just being associated with aSAH and to determine whether smoking cessation decreases this risk, we conducted a case-control study comparing the prevalence and degree of smoking in a consecutive series of patients undergoing surgery for ruptured or unruptured aneurysm with age-, sex-, race-, and geographically matched control subjects culled from the New York Healthy Heart Study. Results: Hypertension alone carries little additional risk for the development of ruptured or unruptured aneurysms. Smoking is a risk factor for not only aneurysmal subarachnoid hemorrhage (Relative Risk [RR]=2.83) but also aneurysm formation (RR=2.33). Coexistent hypertension increases the risk of smoking only minimally. Younger smokers are at threefold higher risk than middle-aged ones. Smoking cessation appears to reduce risk of aneurysmal rupture. The effect of smoking on aneurysm formation and rupture may be dose-dependent. Conclusions: Together these data suggest that smoking, independent of hypertension, plays a critical role in aneurysm development, especially in younger patients, but that physiological mechanisms exist for repair of the damage induced by this toxic insult if cessation is possible.

Original languageEnglish (US)
Pages (from-to)248-253
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Volume8
Issue number4
DOIs
StatePublished - Jul 1999
Externally publishedYes

Fingerprint

Intracranial Aneurysm
Smoking Cessation
Aneurysm
Rupture
Smoking
Population
Hypertension
Poisons
Subarachnoid Hemorrhage
Case-Control Studies
Hemorrhage
Morbidity
Costs and Cost Analysis

Keywords

  • Aneurysm
  • Cerebral
  • Hypertension
  • Risk factors
  • Smoking

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Cigarette smoking and the development and rupture of cerebral aneurysms in a mixed race population : implications for population screening and smoking cessation. / Connolly, E. Sander; Poisik, Alexander; Winfree, Christopher J.; Kim, Louis J.; Huang, Judy; McMahon, Donald J.; Solomon, Robert A.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 8, No. 4, 07.1999, p. 248-253.

Research output: Contribution to journalArticle

Connolly, E. Sander ; Poisik, Alexander ; Winfree, Christopher J. ; Kim, Louis J. ; Huang, Judy ; McMahon, Donald J. ; Solomon, Robert A. / Cigarette smoking and the development and rupture of cerebral aneurysms in a mixed race population : implications for population screening and smoking cessation. In: Journal of Stroke and Cerebrovascular Diseases. 1999 ; Vol. 8, No. 4. pp. 248-253.
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T2 - implications for population screening and smoking cessation

AU - Connolly, E. Sander

AU - Poisik, Alexander

AU - Winfree, Christopher J.

AU - Kim, Louis J.

AU - Huang, Judy

AU - McMahon, Donald J.

AU - Solomon, Robert A.

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AB - Background: Despite advances in the treatment of aneurysmal subarachnoid hemorhage (aSAH), major additional reductions in morbidity will require the identifications of unruptured aneurysms with a high propensity for bleeding. As screening the entire population is currently not cost-effective, risk factors for the presence of unruptured aneurysms must be identified, and if possible, these risk factors should be modified to reduce disease prevalence. Methods: To examine whether cigarette smoking independent of arterial hypertension is a risk factor for the development of cerebral aneurysms rather than just being associated with aSAH and to determine whether smoking cessation decreases this risk, we conducted a case-control study comparing the prevalence and degree of smoking in a consecutive series of patients undergoing surgery for ruptured or unruptured aneurysm with age-, sex-, race-, and geographically matched control subjects culled from the New York Healthy Heart Study. Results: Hypertension alone carries little additional risk for the development of ruptured or unruptured aneurysms. Smoking is a risk factor for not only aneurysmal subarachnoid hemorrhage (Relative Risk [RR]=2.83) but also aneurysm formation (RR=2.33). Coexistent hypertension increases the risk of smoking only minimally. Younger smokers are at threefold higher risk than middle-aged ones. Smoking cessation appears to reduce risk of aneurysmal rupture. The effect of smoking on aneurysm formation and rupture may be dose-dependent. Conclusions: Together these data suggest that smoking, independent of hypertension, plays a critical role in aneurysm development, especially in younger patients, but that physiological mechanisms exist for repair of the damage induced by this toxic insult if cessation is possible.

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