TY - JOUR
T1 - Cigarette smoking and the development and rupture of cerebral aneurysms in a mixed race population
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.
N1 - Funding Information:
Although improved surgical/endovascular techniques and more sophisticated vasopasm management have From the Department of Neurological Surgery, The Neurological Institute, Department of Biostatistics, The Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY. Received July 13, 1998; accepted November 19, 1998. Dr. Connolly is supported by the AANS Young Clinical Investigator Award, the NY Academy of Medicine's Elsberg Fellowship, and the Bayer/AANS-CNS Award for the Investigation of Cerebral Ischemia. Alexander Poisik is supported by an AHA student fellowship training award. This study was supported by a grant from the National Institutes of Health, NCCR, M01-RR00645.
PY - 1999/7
Y1 - 1999/7
N2 - 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.
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.
KW - Aneurysm
KW - Cerebral
KW - Hypertension
KW - Risk factors
KW - Smoking
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U2 - 10.1016/S1052-3057(99)80074-3
DO - 10.1016/S1052-3057(99)80074-3
M3 - Article
C2 - 17895172
AN - SCOPUS:57749103455
SN - 1052-3057
VL - 8
SP - 248
EP - 253
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 4
ER -