Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable

Joseph P. Broderick, Catherine M. Viscoli, Thomas G Brott, Walter N. Kernan, Lawrence M. Brass, Edward Feldmann, Lewis B. Morgenstern, Janet Lee Wilterdink, Ralph I. Horwitz

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

Background and Purpose - To identify risk factors for subarachnoid hemorrhage (SAH) and intracerebral hemorrhage, we designed a case-control study of men and women 18 to 49 years of age (the Hemorrhagic Stroke Project [HSP]). This report focuses on SAH. Methods - Patients were recruited from 44 hospitals in the United States. Cases with SAH must have had a ruptured aneurysm documented by angiography or surgery. Two controls, identified by random digit dialing and matched to each patient for age, sex, race, and telephone exchange, were sought for each case subject. Results - Between 1994 and 1999, 425 patients with SAH were enrolled in HSP, and 312 cases met the criteria for aneurysmal SAH. The present analyses also included 618 matched controls. Of the 312 cases, 66% were current cigarette smokers compared with 30% of controls (adjusted odds ratio [OR], 3.73; 95% CI, 2.67 to 5.21). Cocaine use within the previous 3-day period was reported by 3% of cases and no controls (bivariate exact OR, 24.97; 95% exact CI, 3.95 to ∞; adjusted estimate not calculable). Other independent risk factors in the multivariable model included hypertension (adjusted OR, 2.21; 95% CI, 1.48 to 3.29), low body mass index (OR, 1.59; 95% CI, 1.08 to 2.35), primary family history of hemorrhagic stroke (OR, 3.83; 95% CI, 1.73 to 8.46), caffeine in pharmaceutical products (OR, 2.48; 95 % CI, 1.19 to 5.20), lower educational achievement (OR, 2.36; 95 % CI, 1.44 to 3.87), and nicotine in pharmaceutical products (adjusted estimate not calculable). Conclusions - Aneurysmal SAH may be largely a preventable disease among the young and middle-aged because several prevalent risk factors can be modified by medication (eg, hypertension) or behavioral change (eg, cigarette smoking, cocaine use). The association of caffeine and nicotine in pharmaceutical products and aneurysmal SAH warrants further study.

Original languageEnglish (US)
Pages (from-to)1375-1381
Number of pages7
JournalStroke
Volume34
Issue number6
DOIs
StatePublished - Jun 1 2003

Fingerprint

Subarachnoid Hemorrhage
Odds Ratio
Stroke
Caffeine
Nicotine
Cocaine
Pharmaceutical Preparations
Hypertension
Educational Status
Ruptured Aneurysm
Cerebral Hemorrhage
Telephone
Tobacco Products
Case-Control Studies
Angiography
Body Mass Index
Smoking

Keywords

  • Case-control studies
  • Cerebrovascular disorders
  • Cigarette smoking
  • Cocaine
  • Risk factors
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Broderick, J. P., Viscoli, C. M., Brott, T. G., Kernan, W. N., Brass, L. M., Feldmann, E., ... Horwitz, R. I. (2003). Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke, 34(6), 1375-1381. https://doi.org/10.1161/01.STR.0000074572.91827.F4

Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. / Broderick, Joseph P.; Viscoli, Catherine M.; Brott, Thomas G; Kernan, Walter N.; Brass, Lawrence M.; Feldmann, Edward; Morgenstern, Lewis B.; Wilterdink, Janet Lee; Horwitz, Ralph I.

In: Stroke, Vol. 34, No. 6, 01.06.2003, p. 1375-1381.

Research output: Contribution to journalArticle

Broderick, JP, Viscoli, CM, Brott, TG, Kernan, WN, Brass, LM, Feldmann, E, Morgenstern, LB, Wilterdink, JL & Horwitz, RI 2003, 'Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable', Stroke, vol. 34, no. 6, pp. 1375-1381. https://doi.org/10.1161/01.STR.0000074572.91827.F4
Broderick, Joseph P. ; Viscoli, Catherine M. ; Brott, Thomas G ; Kernan, Walter N. ; Brass, Lawrence M. ; Feldmann, Edward ; Morgenstern, Lewis B. ; Wilterdink, Janet Lee ; Horwitz, Ralph I. / Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. In: Stroke. 2003 ; Vol. 34, No. 6. pp. 1375-1381.
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AU - Brass, Lawrence M.

AU - Feldmann, Edward

AU - Morgenstern, Lewis B.

AU - Wilterdink, Janet Lee

AU - Horwitz, Ralph I.

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N2 - Background and Purpose - To identify risk factors for subarachnoid hemorrhage (SAH) and intracerebral hemorrhage, we designed a case-control study of men and women 18 to 49 years of age (the Hemorrhagic Stroke Project [HSP]). This report focuses on SAH. Methods - Patients were recruited from 44 hospitals in the United States. Cases with SAH must have had a ruptured aneurysm documented by angiography or surgery. Two controls, identified by random digit dialing and matched to each patient for age, sex, race, and telephone exchange, were sought for each case subject. Results - Between 1994 and 1999, 425 patients with SAH were enrolled in HSP, and 312 cases met the criteria for aneurysmal SAH. The present analyses also included 618 matched controls. Of the 312 cases, 66% were current cigarette smokers compared with 30% of controls (adjusted odds ratio [OR], 3.73; 95% CI, 2.67 to 5.21). Cocaine use within the previous 3-day period was reported by 3% of cases and no controls (bivariate exact OR, 24.97; 95% exact CI, 3.95 to ∞; adjusted estimate not calculable). Other independent risk factors in the multivariable model included hypertension (adjusted OR, 2.21; 95% CI, 1.48 to 3.29), low body mass index (OR, 1.59; 95% CI, 1.08 to 2.35), primary family history of hemorrhagic stroke (OR, 3.83; 95% CI, 1.73 to 8.46), caffeine in pharmaceutical products (OR, 2.48; 95 % CI, 1.19 to 5.20), lower educational achievement (OR, 2.36; 95 % CI, 1.44 to 3.87), and nicotine in pharmaceutical products (adjusted estimate not calculable). Conclusions - Aneurysmal SAH may be largely a preventable disease among the young and middle-aged because several prevalent risk factors can be modified by medication (eg, hypertension) or behavioral change (eg, cigarette smoking, cocaine use). The association of caffeine and nicotine in pharmaceutical products and aneurysmal SAH warrants further study.

AB - Background and Purpose - To identify risk factors for subarachnoid hemorrhage (SAH) and intracerebral hemorrhage, we designed a case-control study of men and women 18 to 49 years of age (the Hemorrhagic Stroke Project [HSP]). This report focuses on SAH. Methods - Patients were recruited from 44 hospitals in the United States. Cases with SAH must have had a ruptured aneurysm documented by angiography or surgery. Two controls, identified by random digit dialing and matched to each patient for age, sex, race, and telephone exchange, were sought for each case subject. Results - Between 1994 and 1999, 425 patients with SAH were enrolled in HSP, and 312 cases met the criteria for aneurysmal SAH. The present analyses also included 618 matched controls. Of the 312 cases, 66% were current cigarette smokers compared with 30% of controls (adjusted odds ratio [OR], 3.73; 95% CI, 2.67 to 5.21). Cocaine use within the previous 3-day period was reported by 3% of cases and no controls (bivariate exact OR, 24.97; 95% exact CI, 3.95 to ∞; adjusted estimate not calculable). Other independent risk factors in the multivariable model included hypertension (adjusted OR, 2.21; 95% CI, 1.48 to 3.29), low body mass index (OR, 1.59; 95% CI, 1.08 to 2.35), primary family history of hemorrhagic stroke (OR, 3.83; 95% CI, 1.73 to 8.46), caffeine in pharmaceutical products (OR, 2.48; 95 % CI, 1.19 to 5.20), lower educational achievement (OR, 2.36; 95 % CI, 1.44 to 3.87), and nicotine in pharmaceutical products (adjusted estimate not calculable). Conclusions - Aneurysmal SAH may be largely a preventable disease among the young and middle-aged because several prevalent risk factors can be modified by medication (eg, hypertension) or behavioral change (eg, cigarette smoking, cocaine use). The association of caffeine and nicotine in pharmaceutical products and aneurysmal SAH warrants further study.

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