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Yan X, Wang J, Zhou Y, Yang Z, Wang B, Jiang L, Zhang L, Kou Z, Song J, Li J. Genetically Predicted Vascular Proteins and Risk of Intracranial Aneurysms: A Mendelian Randomization Study. Mol Neurobiol 2024:10.1007/s12035-024-04393-0. [PMID: 39066975 DOI: 10.1007/s12035-024-04393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
The relationship between vascular proteins (VPs) and intracranial aneurysms (IAs) has not been fully elucidated. We used Mendelian randomization (MR) analysis to explore the effect of VPs on IAs. Dataset of aneurysmal subarachnoid hemorrhage (aSAH) [5140 cases and 71,934 controls] and unruptured intracranial aneurysm (uIA) [2070 cases and 71,934 controls] were obtained from individuals of European ancestry. Univariate MR was used to explore the associations between 90 VPs and IAs. Then, we performed multivariate MR (MVMR) to further investigate the identified VP-to-IA estimates. Two-sample MR showed that TNFSF14 was inversely associated with aSAH (odds ratio [OR] = 0.831, 95% CI: 0.713-0.969, p = 0.018). IL-16 (OR = 1.218, 95% CI: 1.032-1.438, p = 0.020) and AgRP (OR = 1.394, 95% CI: 1.048-1.855, p = 0.023) were positively associated with aSAH. HBEGF (OR = 0.642, 95% CI: 0.461-0.894, p = 0.009), MCP-1 (OR = 1.537, 95% CI: 1.007-2.344, p = 0.046), and CX3CL1 (OR = 0.762, 95% CI: 0.581-0.999, 0.049 < p < 0.050) were associated with uIA risk. The MVMR showed that the TNFSF14-to-aSAH estimate remained statistically significant after adjustment for past tobacco smoking, alcohol consumption, systolic blood pressure and body mass index. Our study indicated that low serum TNFSF14 levels might be a potential risk factor for IA rupture. Five VPs (HBEGF, MCP-1, IL-6, CX3CL1, and AgRP) are associated with the risk of IAs (both uIA and aSAH).
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Affiliation(s)
- Xinyang Yan
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jiachen Wang
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yunfei Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Zhongbo Yang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Bo Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Liangchao Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Longxiao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Zhiyan Kou
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jinning Song
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
| | - Jiaxi Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
- Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
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Løvik K, Laupsa-Borge J, Logallo N, Helland CA. Body composition and rupture risk of intracranial aneurysms. Eur J Med Res 2024; 29:297. [PMID: 38790007 PMCID: PMC11127333 DOI: 10.1186/s40001-024-01888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Rupture of an intracranial aneurysm resulting in a subarachnoid hemorrhage (SAH) is a life-threatening situation. Obesity is an increasing health challenge associated with numerous comorbidities. However, recent studies have shown a surprising decreased risk of SAH with increasing body mass index (BMI). The aim was to explore associations between other anthropometric variables and the rupture risk of an intracranial aneurysm, which to our knowledge is lacking in present literature. METHODS Using a bioelectrical impedance analysis device, we performed body composition analyses on 31 patients admitted with aneurysmal SAH (aSAH) and 28 patients with planned intervention on their unruptured aneurysm. We also collected information on comorbidities and relevant risk factors. Logistic regression was used to explore associations between anthropometric variables and patients with ruptured versus unruptured aneurysms. RESULTS Unadjusted estimates showed a significant inverse relationship between body fat percent and aneurysmal rupture (OR [95% CI]: 0.92 [0.86, 0.97], P = 0.009), and between body fat mass and aneurysmal rupture (OR [95% CI]: 0.95 [0.90, 0.99], P = 0.047). These risk relationships remained significant in age- and sex-adjusted analyses for body fat percent (OR [95% CI]: 0.93, [0.87, 0.97], P = 0.028), and body fat mass (OR [95% CI]: 0.95 [0.90, 0.99], P = 0.041). CONCLUSIONS In recent studies showing a paradoxical relation between aSAH and obesity, BMI was the only parameter investigated. We further explored this "obesity paradox" and found lower body fat in aSAH patients compared to UIA. Future studies should investigate these relationships in larger samples. Clinical Trial Registration NCT04613427, November 3, 2020, retrospectively registered.
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Affiliation(s)
- Katja Løvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Nicola Logallo
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Christian A Helland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Zhang B, Dong S, Miao Y, Song G, Yuan F, Liu L, Xia S, Qin Y, Huo X, Wu Z, Miao Z, Mo D, Liu A. Effects of blood lipids and lipid-modifying drugs on intracranial aneurysms. Eur J Neurol 2022; 29:2967-2975. [PMID: 35726534 DOI: 10.1111/ene.15471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We used 2-sample Mendelian randomization (MR) to examine the effects of blood lipids and lipid-modifying drugs on intracranial aneurysm (IA). METHODS Genetic variants for the effects of high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (apo-A1), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apo-B), and triglycerides and targets for lipid-modifying drugs were selected from the genome-wide discovery analyses of the UK Biobank. Summary-level data on IAs were obtained from the International Stroke Genetics Consortium (ISGC). Univariate and multivariate MR analyses were performed. RESULTS Univariate MR analyses showed that the HDL-C was negatively correlated with IA (OR, 0.816; 95% CI, 0.715-0.932; P=0.003) and ruptured IA (rIA) (OR, 0.775, 0.663-0.906; P=0.001). The MVMR-IVW analysis showed that the HDL-C was negatively correlated with IA (OR, 0.655; 95% CI, 0.434-0.988; P=0.043) and rIA (OR, 0.563, 0.347-0.913; P=0.02), and the LDL-C was negatively correlated with IA (OR, 0.402; 95% CI, 0.191-0.848; P=0.017) and rIA (OR, 0.376, 0.160-0.883; P=0.025). Using genetic proxies of known lipid-modifying drugs, we found that the increased HDL-C with CETP proxies was associated with a decreased risk of rIA (OR, 0.852, 0.747-0.973; P=0.018), and the decreased LDL-C with HMGCR proxies were associated with increased risk of IA (OR, 1.772; 95% CI, 1.080-2.908; P=0.024) and rIA (OR, 1.856; 95% CI, 1.022-3.371; P = 0.042). CONCLUSIONS Genetically determined HDL-C and LDL-C reduce the risk of IA and rIA. The effects of different lipid-modifying drugs on IA need to be further investigated.
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Affiliation(s)
- Baorui Zhang
- Beijing Neurosurgical Institute, Capital Medical University, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Siyuan Dong
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Miao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guangrong Song
- Beijing Neurosurgical Institute, Capital Medical University, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Fei Yuan
- Beijing Neurosurgical Institute, Capital Medical University, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Saide Xia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Yongkai Qin
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Capital Medical University, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China
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Rautalin I, Kaprio J, Ingebrigtsen T, Jousilahti P, Løchen ML, Romundstad PR, Salomaa V, Vik A, Wilsgaard T, Mathiesen EB, Sandvei M, Korja M. Obesity Does Not Protect From Subarachnoid Hemorrhage: Pooled Analyses of 3 Large Prospective Nordic Cohorts. Stroke 2022; 53:1301-1309. [PMID: 34753302 PMCID: PMC10510796 DOI: 10.1161/strokeaha.121.034782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several population-based cohort studies have related higher body mass index (BMI) to a decreased risk of subarachnoid hemorrhage (SAH). The main objective of our study was to investigate whether the previously reported inverse association can be explained by modifying effects of the most important risk factors of SAH-smoking and hypertension. METHODS We conducted a collaborative study of three prospective population-based Nordic cohorts by combining comprehensive baseline data from 211 972 adult participants collected between 1972 and 2012, with follow-up until the end of 2018. Primarily, we compared the risk of SAH between three BMI categories: (1) low (BMI<22.5), (2) moderate (BMI: 22.5-29.9), and (3) high (BMI≥30) BMI and evaluated the modifying effects of smoking and hypertension on the associations. RESULTS We identified 831 SAH events (mean age 62 years, 55% women) during the total follow-up of 4.7 million person-years. Compared with the moderate BMI category, persons with low BMI had an elevated risk for SAH (adjusted hazard ratio [HR], 1.30 [1.09-1.55]), whereas no significant risk difference was found in high BMI category (HR, 0.91 [0.73-1.13]). However, we only found the increased risk of low BMI in smokers (HR, 1.49 [1.19-1.88]) and in hypertensive men (HR, 1.72 [1.18-2.50]), but not in nonsmokers (HR, 1.02 [0.76-1.37]) or in men with normal blood pressure values (HR, 0.98 [0.63-1.54]; interaction HRs, 1.68 [1.18-2.41], P=0.004 between low BMI and smoking and 1.76 [0.98-3.13], P=0.06 between low BMI and hypertension in men). CONCLUSIONS Smoking and hypertension appear to explain, at least partly, the previously reported inverse association between BMI and the risk of SAH. Therefore, the independent role of BMI in the risk of SAH is likely modest.
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Affiliation(s)
- Ilari Rautalin
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Finland (I.R., M.K.)
- Department of Public Health, University of Helsinki, Finland (I.R., J.K.)
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Finland (I.R., J.K.)
- Institute for Molecular Medicine FIMM, Helsinki, Finland (J.K.)
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences (T.I.), UiT the Arctic University of Norway, Tromsø
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology (T.I.), University Hospital of North Norway, Tromsø
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland (P.J., V.S.)
| | - Maja-Lisa Løchen
- Department of Community Medicine (M.-L.L., T.W.), UiT the Arctic University of Norway, Tromsø
| | - Pål Richard Romundstad
- Department of Public Health and Nursing (P.R.R., M.S.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland (P.J., V.S.)
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences (A.V.), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Norway (A.V.)
| | - Tom Wilsgaard
- Department of Community Medicine (M.-L.L., T.W.), UiT the Arctic University of Norway, Tromsø
| | - Ellisiv B. Mathiesen
- Department of Clinical Medicine (E.B.M.), UiT the Arctic University of Norway, Tromsø
- Department of Neurology (E.B.M.), University Hospital of North Norway, Tromsø
| | - Marie Sandvei
- Department of Public Health and Nursing (P.R.R., M.S.), Norwegian University of Science and Technology, Trondheim, Norway
- The Cancer Clinic, St Olav’s University Hospital, Trondheim, Norway (M.S.)
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Finland (I.R., M.K.)
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5
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Chen S, Mao J, Chen X, Li Z, Zhu Z, Li Y, Jiang Z, Zhao W, Wang Z, Zhong P, Huang Q. Association Between Body Mass Index and Intracranial Aneurysm Rupture: A Multicenter Retrospective Study. Front Aging Neurosci 2021; 13:716068. [PMID: 34483885 PMCID: PMC8415748 DOI: 10.3389/fnagi.2021.716068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: It has recently emerged the concept of “obesity paradox,” a term used to describe an inverse association between obesity and clinical outcomes in cardiovascular diseases and stroke. The purpose of this study was to investigate the association between body mass index (BMI) and the risk of intracranial aneurysm rupture. Methods: In this study, we conducted a retrospective analysis of a prospectively maintained database of patients with intracranial aneurysms from 21 medical centers in China. A total of 3,965 patients with 4,632 saccular intracranial aneurysms were enrolled. Patients were separated into unruptured (n = 1,977) and ruptured groups (n = 1,988). Univariable and multivariable logistic regression analyses were performed to determine the association between BMI and intracranial aneurysm rupture. Results: Compared to the patients with normal BMI (18.5 to < 24.0 kg/m2), the odds of intracranial aneurysm rupture were significantly lower in patients with BMI 24.0 to < 28.0 kg/m2 (OR = 0.745, 95% CI = 0.638–0.868, P = 0.000) and patients with BMI ≥ 28.0 kg/m2 (OR = 0.628, 95% CI = 0.443–0.890, P = 0.009). Low BMI (<18.0 kg/m2) was not associated with intracranial aneurysm rupture (OR = 0.894, 95% CI = 0.483–1.657, P = 0.505). For males, both the BMI 24.0 to < 28.0 kg/m2 (OR = 0.606, 95% CI = 0.469–0.784, P = 0.000) and the BMI ≥ 28.0 kg/m2 (OR = 0.384, 95% CI = 0.224–0.658, P = 0.001) were associated with a lower rupture risk, whereas the inverse association was not observed in females. Both the BMI 24.0 to < 28.0 kg/m2 (OR = 0.722 for aged 50–60y, 95% CI = 0.554–0.938, P = 0.015; OR = 0.737 for aged >60y, 95% CI = 0.586–0.928, P = 0.009) and the BMI ≥ 28.0 kg/m2 (OR = 0.517 for aged 50–60y, 95% CI = 0.281–0.950, P = 0.0034; OR = 0.535 for aged >60y, 95% CI = 0.318–0.899, P = 0.0018) was associated with a lower rupture risk in patients aged ≥50 years, whereas the association was not significant in patients aged <50 years. Conclusions: Increased BMI is significantly and inversely associated with saccular intracranial aneurysm rupture in males and patients aged ≥50 years.
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Affiliation(s)
- Sifang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jianyao Mao
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xi Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhangyu Li
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhi Zhu
- Department of Neurosurgery, Heze Municipal Hospital, Heze, China
| | - Yukui Li
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhengye Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wenpeng Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhanxiang Wang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Neuroscience, School of Medicine, Institute of Neurosurgery, Xiamen University, Xiamen, China
| | - Ping Zhong
- BE and Phase I Clinical Trial Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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Zimelewicz Oberman D, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries. World Neurosurg 2021; 154:e155-e162. [PMID: 34273549 DOI: 10.1016/j.wneu.2021.06.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.
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Affiliation(s)
| | | | | | - Cristina Elizondo
- Department of Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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An association of low high-density lipoprotein levels with recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2021; 163:1061-1068. [PMID: 33146806 DOI: 10.1007/s00701-020-04638-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common illness in neurosurgical practice with a substantial recurrence rate. Previous studies found that serum lipids were associated with the risk of stroke and subarachnoid hemorrhage. In the current study, we aimed to identify the relationship between serum lipids and CSDH recurrence. METHODS The medical records of 274 consecutive surgical patients with CSDH in our department were reviewed and analyzed. Patients were separated into recurrence and non-recurrence groups. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify serum lipids (triglycerides, total cholesterol, LDL, HDL) and other potential predictors associated with CSDH recurrence, and the performance of predictors was assessed with receiver operating characteristic (ROC) curve. RESULTS Of the 274 patients included in the study, 42 (15.3%) experienced at least 1 recurrence of CSDH. Univariate analysis showed that age, hypertension, diabetes mellitus, anticoagulant use, triglycerides, HDL, and midline shift were all significantly associated with CSDH recurrence. Multivariable Cox regression analysis found that only age, diabetes mellitus, midline shift, and HDL level were independent risk factors for CSDH recurrence. A higher HDL level (HR = 0.929, 95% CI 0.905-0.953) was significantly associated with a lower risk of recurrence, and ROC curve analysis revealed that the optimal HDL cut-off value as a predictor was 37.45 mg/dl. CONCLUSIONS Low level of high-density lipoprotein is significantly associated with recurrence of chronic subdural hematoma.
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Sundström J, Söderholm M, Söderberg S, Alfredsson L, Andersson M, Bellocco R, Björck M, Broberg P, Eriksson M, Eriksson M, Forsberg B, Fransson EI, Giedraitis V, Theorell-Haglöw J, Hallqvist J, Hansson PO, Heller S, Håkansson N, Ingelsson M, Janson C, Järvholm B, Khalili P, Knutsson A, Lager A, Lagerros YT, Larsson SC, Leander K, Leppert J, Lind L, Lindberg E, Magnusson C, Magnusson PKE, Malfert M, Michaëlsson K, Nilsson P, Olsson H, Pedersen NL, Pennlert J, Rosenblad A, Rosengren A, Torén K, Wanhainen A, Wolk A, Engström G, Svennblad B, Wiberg B. Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults. Int J Epidemiol 2020; 48:2018-2025. [PMID: 31363756 DOI: 10.1093/ije/dyz163] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 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. METHODS We obtained individual participant data of 949 683 persons (330 334 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. RESULTS During 13 704 959 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)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 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. CONCLUSIONS 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.
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Affiliation(s)
- Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, University of Milano-Biocca, Milan, Italy.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Per Broberg
- Department of Clinical Sciences, Cancer Epidemiology, Lund University, Lund, Sweden
| | - Maria Eriksson
- Department of Neurosurgery, Umeå University, Umeå, Sweden
| | - Marie Eriksson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå University, Umeå, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eleonor I Fransson
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Johan Hallqvist
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/ Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Heller
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Niclas Håkansson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Järvholm
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Payam Khalili
- Department of Cardiology and Acute Internal Medicine, Central Hospital, Karlstad, Sweden
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Ostersund, Sweden
| | - Anton Lager
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jerzy Leppert
- Centre for Clinical Research Västerås, Västmanland Region, and Uppsala University, Västerås, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Cecilia Magnusson
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mauricio Malfert
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Håkan Olsson
- Department of Clinical Sciences, Cancer Epidemiology, Lund University, Lund, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andreas Rosenblad
- Centre for Clinical Research Västerås, Västmanland Region, and Uppsala University, Västerås, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/ Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Bodil Svennblad
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bernice Wiberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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9
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Low total cholesterol and high density lipoprotein are independent predictors of poor outcomes following aneurysmal subarachnoid hemorrhage: A preliminary report. Clin Neurol Neurosurg 2020; 197:106062. [PMID: 32688095 DOI: 10.1016/j.clineuro.2020.106062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH. METHODS We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed. RESULTS There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and Hunt & Hess score of 2.8 ± 0.1, included for analysis. Those with a low TC < 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL < 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm. CONCLUSIONS Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.
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10
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Watanabe J, Kakehi E, Kotani K, Kayaba K, Nakamura Y, Ishikawa S. High-Density Lipoprotein Cholesterol and Risk of Stroke Subtypes: Jichi Medical School Cohort Study. Asia Pac J Public Health 2020; 32:27-34. [PMID: 31970995 DOI: 10.1177/1010539519900685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to investigate the relationship between high-density lipoprotein cholesterol (HDL-C) concentration and the incident stroke subtypes. We enrolled 11 027 participants between the ages of 18 and 90 years without a history of stroke in 12 Japanese communities. Cox's regression models were used for stroke subtypes, adjusted for traditional risk factors, according to the categories based on HDL-C concentrations: 1.04 to 1.55 mmol/L, ≥1.56 mmol/L, and <1.03 mmol/L (as the reference). During a mean follow-up of 10.7 years, 412 stroke events had occurred. However, HDL-C was not significantly associated with the incidence of cerebral infarction and subarachnoid hemorrhage. High HDL-C concentration was associated with a decreased incidence of intracerebral hemorrhage in women (hazard ratio = 0.23; 95% confidence interval = 0.06-0.89), but not in men (hazard ratio = 0.73; 95% confidence interval = 0.27-1.97). Therefore, high HDL-C concentration might have a protective effect on the incidence of intracerebral hemorrhage, particularly in women.
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Affiliation(s)
- Jun Watanabe
- Jichi Medical University, Shimotsuke City, Tochigi, Japan
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11
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Rehman S, Sahle BW, Chandra RV, Dwyer M, Thrift AG, Callisaya M, Breslin M, Phan HT, Otahal P, Gall S. Sex differences in risk factors for aneurysmal subarachnoid haemorrhage: Systematic review and meta-analysis. J Neurol Sci 2019; 406:116446. [PMID: 31521957 DOI: 10.1016/j.jns.2019.116446] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/24/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid haemorrhage (aSAH) disproportionally affects women. We conducted a systematic review and meta-analysis to explore sex differences in aSAH risk factors. METHODS Case-control/cohort studies were searched to November 2017 with sex-specific risk factors for aSAH. Meta-analysis was performed when a risk factor was reported in ≥2 studies. RESULTS Of 31 studies, 22 were eligible for meta-analysis. Female sex was associated with greater odds of aSAH (HRadjusted 1.90 [1.47-2.46]. There was no detectable difference between the sexes for hypertension (ORadjusted: men 3.13 [2.26-4.34]; women 3.65 [2.87-4.63], p = .18), smoking (ORadjusted: men 2.96 [1.68-5.21]; women 3.11 [1.21-7.97], p = .95), aSAH family history, systolic blood pressure, age and some genetic variations. Alcohol (ORadjusted: men 1.50 [1.04-2.17]; women 0.83 [0.48-1.45], p = .003), high alanine aminotransferase levels, and some gene variants increased the risk of aSAH in men. Reproductive factors, divorce and some genetic variations increased the risk in women. High aspartate aminotransferase levels in men and, diabetes (ORadjusted: men 0.57 [0.32-1.01]; women 0.24 [0.13-0.43], p = .01) and parity in women reduced aSAH risk. CONCLUSION We recommend sex-specific re-analysis of existing studies of aSAH risk factors. Known aSAH risk factors (hypertension, smoking and alcohol consumption) should be targeted to prevent aSAH in men and women. Registration PROSPERO (ID: CRD42018091521).
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Affiliation(s)
- Sabah Rehman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Berhe W Sahle
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Mitchell Dwyer
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Australia.
| | | | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Monash University, Melbourne, Australia.
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Monash University, Melbourne, Australia; National Heart Foundation, Australia.
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12
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Decreased Antiatherogenic Protein Levels are Associated with Aneurysm Structure Alterations in MR Vessel Wall Imaging. J Stroke Cerebrovasc Dis 2019; 28:2221-2227. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022] Open
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13
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Lindbohm JV, Rautalin I, Jousilahti P, Salomaa V, Kaprio J, Korja M. Physical activity associates with subarachnoid hemorrhage risk- a population-based long-term cohort study. Sci Rep 2019; 9:9219. [PMID: 31239477 PMCID: PMC6592878 DOI: 10.1038/s41598-019-45614-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/10/2019] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Joni V Lindbohm
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland. .,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland.
| | - Ilari Rautalin
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
| | - Pekka Jousilahti
- National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Jaakko Kaprio
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland.,Institute for Molecular Medicine FIMM, P.O. Box 20, FI-00014, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
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14
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Giordan E, Sorenson TJ, Brinjikji W, Vine R, Lanzino G. Risk factors for growth of conservatively managed unruptured intracranial aneurysms. Acta Neurochir (Wien) 2018; 160:2419-2423. [PMID: 30415386 DOI: 10.1007/s00701-018-3729-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Unruptured intracranial aneurysms (UIAs) occur in 2-3% of the adult population, but, once discovered, do not always require treatment. Untreated patients are usually followed with serial imaging to identify interval growth. In this study, we assessed the risk and risk factors for growth in a homogenous series of patients with conservatively managed UIAs. METHODS Data from consecutive patients without history of subarachnoid hemorrhage and a conservatively managed UIA were retrospectively reviewed and only patients with at least 2 years of radiological follow-up were included in our study. We evaluated patients for the incidence of UIA growth, as well as analyzed risk factors for UIA growth. RESULTS In 349 patients and 385 conservatively managed UIAs with 2210 patient-years of radiological follow-up, the risk of growth was 2.9% per aneurysm-year. Size (diameter greater than 5 mm), location (basilar artery apex), and weight loss (decrease in BMI over follow-up period) were all significantly associated with increased risk of UIA growth. There was a greater risk of UIA growth during the first 3 years of follow-up (7.5% per aneurysm-year) compared to the remaining years (2.7% per aneurysm-year). CONCLUSIONS Conservatively managed UIAs in patients without prior history of SAH have a 2.9% risk of growth per aneurysm-year. UIAs greater than 5 mm in diameter, those located at the basilar artery apex, or patients who experience a decrease in BMI are more likely to grow and warrant closer follow-up. The risk of aneurysm growth is increased in the few years after diagnosis and decreases afterward.
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15
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Huang Q, Shang-Guan HC, Wu SY, Yao PS, Sun Y, Zeng YL, Zheng SF, Chen GR, Lin YX, Kang DZ. High-Density Lipoprotein Is Associated with Progression of Intracranial Aneurysms. World Neurosurg 2018; 120:e234-e240. [PMID: 30121407 DOI: 10.1016/j.wneu.2018.08.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We tested the hypothesis that high-density lipoprotein (HDL) is associated with intracranial aneurysm growth and rupture. METHODS We used an observational cohort study design. Age, sex, admission systolic blood pressure (SBP), diabetes, hypertension, coronary artery disease, aneurysmal rupture, apolipoprotein (APO)-A1, APO-B, HDL, low-density lipoprotein, triglycerides, cholesterol, and aneurysm location and size were recorded. Aneurysms <8 mm were categorized as small. RESULTS The data from 581 patients with intracranial aneurysms were analyzed. The predictive factors for small size of aneurysms were female sex (odds ratio [OR], 0.630; 95% confidence interval [CI], 0.428-0.927; P = 0.019) and higher HDL (OR, 0.327; 95% CI, 0.159-0.672; P = 0.0002). In the subgroup of male patients, lower HDL was the only risk factor for large size (P = 0.015). The predictors of aneurysmal rupture were small size (OR, 0.875; 95% CI, 0.842-0.910; P = 0.000), higher HDL (OR, 3.716; 95% CI, 1.623-8.509; P = 0.002), no coronary artery disease (OR, 4.736; 95% CI, 1.528-14.681; P = 0.007), lower APO-A1 (OR, 0.202; 95% CI, 0.064-0.641; P = 0.007), and higher admission SBP (OR, 1.024; 95% CI, 1.015-1.032; P = 0.000). An HDL/aneurysm size ratio >0.31 was associated with a 46.2-fold increased likelihood of aneurysmal rupture (OR, 46.214; 95% CI, 13.386-159.548; P = 0.002). CONCLUSIONS The HDL level was inversely associated with intracranial aneurysm growth, especially in men. Higher HDL levels and small aneurysm size contributed to a greater risk of aneurysmal rupture. An HDL/size ratio >0.31 was a valuable predictor of intracranial rupture.
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Affiliation(s)
- Qing Huang
- The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Huang-Cheng Shang-Guan
- Department of Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Si-Ying Wu
- The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Pei-Sen Yao
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yi Sun
- Department of Neurosurgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi-Le Zeng
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shu-Fa Zheng
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Rong Chen
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - De-Zhi Kang
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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16
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Lindbohm J, Korja M, Jousilahti P, Salomaa V, Kaprio J. Adverse lipid profile elevates risk for subarachnoid hemorrhage: A prospective population-based cohort study. Atherosclerosis 2018; 274:112-119. [PMID: 29772479 DOI: 10.1016/j.atherosclerosis.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Studies report that both high and low total cholesterol (TC) elevates SAH risk. There are few prospective studies on high-density lipoproteins (HDL-C) and low-density lipoproteins (LDL-C), and apparently none concerns apolipoproteins A and B. We aimed to clarify the association between lipid profile and SAH risk. METHODS The National FINRISK study provided risk-factor data recorded at enrolment between 1972 and 2007. During 1.52 million person-years of follow-up until 2014, 543 individuals suffered from incident hospitalized SAH or outside-hospital-fatal SAH. Cox proportional hazards model was used to calculate the hazard ratios and multiple imputation predicted ApoA1, ApoB, and LDL-C values for cohorts from a time before apolipoprotein-measurement methods were available. RESULTS One SD elevation (1.28 mmol/l) in TC elevated SAH risk in men (hazard ratio (HR) 1.15 (95% CIs 1.00-1.32)). Low HDL-C levels increased SAH risk, as each SD decrease (0.37 mmol/l) in HDL-C raised the risk in women (HR 1.29 (95% CIs 1.07-1.55)) and men (HR 1.20 (95% CIs 1.14-1.27)). Each SD increase (0.29 g/l) in ApoA1 decreased SAH risk in women (HR 0.85 (95% CIs 0.74-0.97)) and men (HR 0.88 (95% CIs 0.76-1.02)). LDL-C (SD 1.07 mmol/l) and ApoB (SD 0.28 g/l) elevated SAH risk in men with HR 1.15 (95% CIs 1.01-1.31) and HR 1.26 (95% CIs 1.10-1.44) per one SD increase. Age did not change these findings. CONCLUSIONS An adverse lipid profile seems to elevate SAH risk similar to its effect in other cardiovascular diseases, especially in men. Whether SAH incidence diminishes with increasing statin use remains to be studied.
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Affiliation(s)
- Joni Lindbohm
- Department of Public Health, University of Helsinki, P.O. Box 20, FI-00014, Helsinki, Finland; Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland.
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Health, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Veikko Salomaa
- Department of Health, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, P.O. Box 20, FI-00014, Helsinki, Finland; Institute for Molecular Medicine FIMM, P.O. Box 20, FI-00014, Helsinki, Finland
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17
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Can A, Castro VM, Dligach D, Finan S, Yu S, Gainer V, Shadick NA, Savova G, Murphy S, Cai T, Weiss ST, Du R. Lipid-Lowering Agents and High HDL (High-Density Lipoprotein) Are Inversely Associated With Intracranial Aneurysm Rupture. Stroke 2018; 49:1148-1154. [PMID: 29622625 DOI: 10.1161/strokeaha.117.019972] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/23/2018] [Accepted: 02/15/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Growing evidence from experimental animal models and clinical studies suggests the protective effect of statin use against rupture of intracranial aneurysms; however, results from large studies detailing the relationship between intracranial aneurysm rupture and total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and lipid-lowering agent use are lacking. METHODS The medical records of 4701 patients with 6411 intracranial aneurysms diagnosed at the Massachusetts General Hospital and the Brigham and Women's Hospital between 1990 and 2016 were reviewed and analyzed. Patients were separated into ruptured and nonruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the effects of lipids (total cholesterol, LDL, and HDL) and lipid-lowering medications on intracranial aneurysm rupture risk. Propensity score weighting was used to account for differences in baseline characteristics of the cohorts. RESULTS Lipid-lowering agent use was significantly inversely associated with rupture status (odds ratio, 0.58; 95% confidence interval, 0.47-0.71). In a subgroup analysis of complete cases that includes both lipid-lowering agent use and lipid values, higher HDL levels (odds ratio, 0.95; 95% confidence interval, 0.93-0.98) and lipid-lowering agent use (odds ratio, 0.41; 95% confidence interval, 0.23-0.73) were both significantly and inversely associated with rupture status, whereas total cholesterol and LDL levels were not significant. A monotonic exposure-response curve between HDL levels and risk of aneurysmal rupture was obtained. CONCLUSIONS Higher HDL values and the use of lipid-lowering agents are significantly inversely associated with ruptured intracranial aneurysms.
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Affiliation(s)
- Anil Can
- From the Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.C., R.D.)
| | - Victor M Castro
- Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M
| | - Dmitriy Dligach
- Boston Children's Hospital Informatics Program, MA (D.D., S.F., G.S.).,Department of Computer Science, Loyola University, Chicago, IL (D.D.)
| | - Sean Finan
- Boston Children's Hospital Informatics Program, MA (D.D., S.F., G.S.)
| | - Sheng Yu
- Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.Y., S.T.W.).,Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.)
| | - Vivian Gainer
- Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (N.A.S.)
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, MA (D.D., S.F., G.S.)
| | - Shawn Murphy
- Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.,Department of Neurology, Massachusetts General Hospital, Boston (S.M.)
| | - Tianxi Cai
- Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA (T.C.)
| | - Scott T Weiss
- Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.Y., S.T.W.).,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA (S.T.W., R.D.)
| | - Rose Du
- From the Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.C., R.D.) .,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA (S.T.W., R.D.)
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18
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Lindbohm JV, Kaprio J, Jousilahti P, Salomaa V, Korja M. Risk Factors of Sudden Death From Subarachnoid Hemorrhage. Stroke 2017; 48:2399-2404. [PMID: 28739833 DOI: 10.1161/strokeaha.117.018118] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/21/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE One in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We studied the differences in risk factors between hospitalized SAH and sudden-death SAH patients. METHODS The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.52 million person-years. The Cox proportional hazards model calculated hazard ratios (HRs), with all analyses adjusted for known SAH risk factors, marital status, and socioeconomic status. A competing risks model analyzed differences in risk factors between hospitalized SAHs and sudden-death SAHs. RESULTS We identified 98 sudden-death SAHs and 445 hospitalized SAHs confirmed by autopsy or by standard SAH diagnostics. Increase by 5 cigarettes smoked per day elevated sudden-death SAH risk (HR, 1.28; 95% confidence interval [CI], 1.17-1.39) more than hospitalized SAH risk (HR, 1.19; 95% CI, 1.13-1.24; P=0.05 for difference). Per SD (21.4 mm Hg) increase, systolic blood pressure elevated risk of sudden-death SAH (HR, 1.34; 95% CI, 1.09-1.65) more than risk for hospitalized SAH (HR, 1.25; (95% CI, 1.12-1.38; P=0.05 for difference). Participants living without a partner were at elevated risk of sudden-death SAH (HR, 2.09; 95% CI, 1.33-3.28) but not of hospitalized SAH. No sudden-death SAHs occurred in normotensive never smokers aged <50 years. CONCLUSIONS Sudden-death SAH risk seems to be highest among those individuals with the most adverse risk factor profiles and among those who live without a partner, whereas it is rare among normotensive never smokers aged <50 years.
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Affiliation(s)
- Joni Valdemar Lindbohm
- From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.).
| | - Jaakko Kaprio
- From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.)
| | - Pekka Jousilahti
- From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.)
| | - Veikko Salomaa
- From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.)
| | - Miikka Korja
- From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.)
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Yao XY, Jiang CQ, Jia GL, Chen G. Diabetes mellitus and the risk of aneurysmal subarachnoid haemorrhage: A systematic review and meta-analysis of current evidence. J Int Med Res 2016; 44:1141-1155. [PMID: 28322094 PMCID: PMC5536738 DOI: 10.1177/0300060516666426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective This systematic review aimed to define the relationship between diabetes mellitus (DM) and the risk of aneurysmal subarachnoid haemorrhage (aSAH). Methods Studies associated with DM and aSAH published until March 2016 were retrieved from Pubmed, Embase, Web of Science, and Cochrane Library databases. A random-effects model was used to calculate the relative risks (RRs) with 95% confidence intervals (CIs). Results Eighteen observational studies were retrieved. The overall RRs for DM and aSAH were RRs = 0.59 (0.44, 0.79), with moderate heterogeneity (I2 = 55.7%, Pheterogeneity = 0.000). Subgroup analysis by study quality revealed a reduced association between DM and aSAH risk in high quality studies only (RRs = 0.40, 95% CI: 0.29, 0.56; I2 = 0.0%, Pheterogeneity = 0.549), therefore study quality may be a source of heterogeneity. Conclusion A potential decreased risk of aSAH in DM patients was found in high quality studies. Further studies are required to confirm this causal relationship and to investigate the biological mechanisms.
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Affiliation(s)
- Xi-Yang Yao
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cai-Qi Jiang
- 2 Department of Neurosurgery, Suzhou Xiangcheng People's Hospital, Suzhou, China
| | - Gen-Lai Jia
- 3 Department of Neurosurgery, The People's Hospital of Rugao, Jiangsu Rugao, China
| | - Gang Chen
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Guo Y, Yue XJ, Li HH, Song ZX, Yan HQ, Zhang P, Gui YK, Chang L, Li T. Overweight and Obesity in Young Adulthood and the Risk of Stroke: a Meta-analysis. J Stroke Cerebrovasc Dis 2016; 25:2995-3004. [PMID: 27618195 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/11/2016] [Accepted: 08/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A systematic review assessing the association between overweight and obesity in young adulthood and stroke risk is lacking. Therefore, we conducted a meta-analysis to evaluate the association between overweight and obesity in young adulthood and stroke risk. METHODS We systematically searched PubMed and Embase databases for related studies of human subjects in the English language. Two investigators independently selected original studies in a 2-step process. Fixed- and random-effects models were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). Subgroup analyses were also performed. RESULTS Eight studies met the inclusion criteria. The pooled adjusted RR of stroke was 1.36 (95% CI: 1.28-1.44) for overweight in young adulthood and 1.81 (95% CI: 1.45-2.25) for obesity in young adulthood. In subgroup analyses, overweight and obesity in young adulthood increased the risk of stroke in most groups, except for the group of stroke subtype. For ischemic stroke, the adjusted RR was 1.40 (95% CI: 1.24-1.58) for overweight in young adulthood and 1.78 (95% CI: 1.003-3.16) for obesity in young adulthood, whereas adjusted RR for hemorrhagic stroke was 1.25 (95% CI: .83-1.90) for overweight in young adulthood and 1.80 (95% CI: .97-3.35) for obesity in young adulthood. CONCLUSIONS Overweight and obesity in young adulthood are associated with an increased risk of stroke, probably, independent of other cardiovascular risk factors. The risk effect gradually increases with increasing body weight.
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Affiliation(s)
- Yan Guo
- Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Xue-Jing Yue
- Clinical Skills Training Center, Xinxiang Medical University, Xinxiang, Henan, China
| | - He-Hua Li
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Zhi-Xiu Song
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Hai-Qing Yan
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Ping Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Yong-Kun Gui
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Li Chang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Tong Li
- Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China.
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Lindbohm JV, Kaprio J, Jousilahti P, Salomaa V, Korja M. Sex, Smoking, and Risk for Subarachnoid Hemorrhage. Stroke 2016; 47:1975-81. [DOI: 10.1161/strokeaha.116.012957] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Women are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among prospective studies. We studied associations between smoking habits and SAH and interactions between known SAH risk factors in a prospective population-based study.
Methods—
The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.38 million person-years. We used the Cox proportional hazards model to calculate hazard ratios and evaluated additive and multiplicative interactions between study variables, with all analyses adjusted for known SAH risk factors.
Results—
During follow-up, we identified 492 SAHs (266 women). Smoking had a linear dose-dependent and cumulative association with risk for SAH in both sexes. Women smoking >20 cigarettes per day had a hazard ratio of 8.35 (95% confidence interval, 3.86–18.06) compared with a hazard ratio of 2.76 (95% confidence interval, 1.68–4.52) in men in the same cigarettes per day group. Hazard ratios differed by sex in all cigarettes per day and pack-year categories; this association was stronger in women in all categories (
P
=0.01). When an adjusted model included interaction terms between sex and cigarettes per day or pack-years, female sex was no longer an independent SAH risk factor. Former smokers had a markedly decreased risk for SAH in both sexes when compared with current smokers.
Conclusions—
Smoking has a dose-dependent and cumulative association with SAH risk, and this risk is highest in female heavy smokers. Vulnerability to smoking seems to explain in part the increased SAH risk in women.
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Affiliation(s)
- Joni Valdemar Lindbohm
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Jaakko Kaprio
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Pekka Jousilahti
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Veikko Salomaa
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Miikka Korja
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
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Lindbohm JV, Kaprio J, Korja M. Cholesterol as a Risk Factor for Subarachnoid Hemorrhage: A Systematic Review. PLoS One 2016; 11:e0152568. [PMID: 27077917 PMCID: PMC4831795 DOI: 10.1371/journal.pone.0152568] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/16/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The role played by total cholesterol (TC) in risk for subarachnoid hemorrhage (SAH) is unclear because studies report both high and low TC each as a risk factor. We performed a systematic review to clarify associations between lipid profile and SAH. METHODS Our literature search comprised Pubmed, Scopus, and Cochrane Library databases with no language, publication year, or study type limitations. The Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) checklist guided our reporting. Data forms adapted from the Critical Appraisal Skills Program (CASP), and Cochrane Collaboration guidelines provided a platform for risk-of-bias evaluation. We used a random effects model to calculate pooled estimates and assessed heterogeneity with I2-statistics. RESULTS Of the final 21 studies reviewed, 12 were prospective and 9 retrospective. All studies assessed TC, four assessed HDL, and none LDL in risk for SAH. Heterogeneity among all, retrospective, and Asian studies was high (I2 = 79.5%, I2 = 89.0%, and I2 = 84.3%) and considerable in prospective (I2 = 46.0%). We therefore focused on qualitative analysis and found that only two studies had a low risk of bias. According to these studies high TC increases risk for SAH in men, whereas the role of HDL remained unclear. CONCLUSION The low-risk-of-bias studies suggest that elevated TC levels elevate risk for SAH in men. Due to the high prevalence of hypercholesterolemia, population attributable risk (PAR) of hypercholesterolemia may exceed the PARs of smoking and hypertension in men. Apart from diabetes and obesity, the risk-factor profile of SAH seems to resemble that of other cerebrovascular diseases, at least in men.
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Affiliation(s)
- Joni Valdemar Lindbohm
- Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
- * E-mail:
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland
- National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
- Institute for Molecular Medicine FIMM, P.O. Box 20, FI-00014, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
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Dhandapani S, Aggarwal A, Srinivasan A, Meena R, Gaudihalli S, Singh H, Dhandapani M, Mukherjee KK, Gupta SK. Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation? Surg Neurol Int 2015; 6:S543-8. [PMID: 26664869 PMCID: PMC4653325 DOI: 10.4103/2152-7806.168067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/18/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Serum lipid abnormalities are known to be important risk factors for vascular disorders. However, their role in delayed cerebral ischemia (DCI), the major cause of morbidity after subarachnoid hemorrhage (SAH) remains unclear. This study was an attempt to evaluate the spectrum of lipid profile changes in SAH compared to matched controls, and their relation with the occurrence of DCI. METHODS Admission serum lipid profile levels were measured in patients of SAH and prospectively studied in relation to various factors and clinical development of DCI. RESULTS Serum triglyceride (TG) levels were significantly lower among SAH patients compared to matched controls (mean [±standard deviation (SD)] mg/dL: 117.3 [±50.4] vs. 172.8 [±89.1], P = 0.002), probably because of energy consumption due to hypermetabolic response. Patients who developed DCI had significantly higher TG levels compared to those who did not develop DCI (mean [±SD] mg/dL: 142.1 [±56] vs. 111.9 [±54], P = 0.05). DCI was noted in 62% of patients with TG >150 mg/dL, compared to 22% among the rest (P = 0.01). Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and lipoprotein (a) neither showed a significant difference between SAH and controls and nor any significant association with DCI. Multivariate analysis using binary logistic regression adjusting for the effects of age, sex, systemic disease, World Federation of Neurosurgical Societies grade, Fisher grade, and clipping/coiling, revealed higher TG levels to have significant independent association with DCI (P = 0.01). CONCLUSIONS Higher serum TG levels appear to be significantly associated with DCI while other lipid parameters did not show any significant association. This may be due to their association with remnant cholesterol or free fatty acid-induced lipid peroxidation.
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Affiliation(s)
- Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anirudh Srinivasan
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Meena
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Gaudihalli
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harnarayan Singh
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manju Dhandapani
- Department of Neurosurgery, Neuro-nursing Division, National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan K Mukherjee
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil K Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rosseland LA, Narum J, Stubhaug A, Kongsgaard U, Sorteberg W, Sorteberg A. The effect of tracheotomy on drug consumption in patients with acute aneurysmal subarachnoid hemorrhage: an observational study. BMC Anesthesiol 2015; 15:47. [PMID: 25883531 PMCID: PMC4399106 DOI: 10.1186/s12871-015-0029-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/25/2015] [Indexed: 11/20/2022] Open
Abstract
Background Patients with aneurysmal subarachnoid hemorrhage (aSAH) are common in intensive care units (ICU). In patients with aSAH, sedation is used as a neuroprotective measure in order to secure adequate cerebral perfusion pressure (CPP). Compared with the use of an endotracheal tube, a tracheotomy has the advantage of securing the airway at a much lower level of distress, and aSAH patients can often be awakened more rapidly. Little is known about the impact of tracheotomy on the consumption of sedative/analgesic and vasoactive drugs and the maintenance of CPP within defined limits in aSAH patients. Methods We conducted an observational study of aSAH patients who underwent percutaneous tracheotomy. A prospective registry of patient data was supplemented with retrospective retrievals from medical records. Sedative, analgesic and vasoactive drug doses were registered for 3 days prior to and after percutaneous tracheotomy, respectively. Blood pressure, CPP, and the mode of mechanical ventilation were registered 24 h prior to and after tracheotomy. Results Between January 2001 and June 2009, 902 aSAH patients were admitted to our hospital; 74 (8%) were deeply comatose/dying upon arrival. The ruptured aneurysm was repaired in 828 patients (surgical repair 50%) and percutaneous tracheotomy was performed 182 times in 178 patients (59 men and 119 women). This subpopulation (178 of 828 patients) was significantly older (56 vs. 53 years) and presented with a more severe Hunt & Hess grade (p < 0.001). Percutaneous tracheotomy caused a marked decline in mean daily consumption of the analgesics/sedatives fentanyl, midazolam, and propofol, as well as the vasoactive drugs noradrenaline and dopamine. These declines were statistically and clinically significant. The mean CPP was 76 mmHg (SD 8.6) the day before and 79 mmHg (SD 9.6) 24 h after percutaneous tracheotomy. After percutaneous tracheotomy, mechanical ventilatory support could be reduced to a patient-controlled ventilatory support mode in a significant number of patients (p < 0.001). Conclusions Percutaneous tracheotomy in aSAH patients is a swift procedure with low risk that is associated with a significant decline in the consumption of sedative/analgesic and vasoactive drugs while clinical surveillance parameters remain stable or improve.
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Affiliation(s)
- Leiv Arne Rosseland
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, 0027 Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Narum
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, 0027 Norway
| | - Audun Stubhaug
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, 0027 Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulf Kongsgaard
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, 0027 Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wilhelm Sorteberg
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Angelika Sorteberg
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Lee K, Choi HA, Edwards N, Chang T, Sladen RN. Perioperative critical care management for patients with aneurysmal subarachnoid hemorrhage. Korean J Anesthesiol 2014; 67:77-84. [PMID: 25237442 PMCID: PMC4166392 DOI: 10.4097/kjae.2014.67.2.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/20/2014] [Accepted: 02/20/2014] [Indexed: 01/01/2023] Open
Abstract
Despite significant regional and risk factor-related variations, the overall mortality rate in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) remains high. Compared to ischemic stroke, which is typically irreversible, hemorrhagic stroke tends to carry a higher mortality, but patients who do survive have less disability. Technologies to monitor and treat complications of SAH have advanced considerably in recent years, but good long-term functional outcome still depends on prompt diagnosis, early aggressive management, and avoidance of premature withdrawal of support. Endovascular procedures and open craniotomy to secure a ruptured aneurysm represent some of the numerous critical steps required to achieve the best possible result. In this review, we have attempted to provide a contemporary, evidence-based outline of the perioperative critical care management of patients with SAH. This is a challenging and potentially fatal disease with a wide spectrum of severity and complications and an often protracted course. The dynamic nature of this illness, especially in its most severe forms, requires considerable flexibility in clinician management, especially given the panoply of available treatment modalities. Judicious hemodynamic monitoring and adaptive therapy are essential to respond to the fluctuating nature of cerebral vasospasm and the varying oxygen demands of the injured brain that may readily induce acute or delayed cerebral ischemia.
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Affiliation(s)
- Kiwon Lee
- Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, The Mischer Neuroscience Institute, Memorial Hermann Texas Medical Center, Houston, Texas, USA
| | - H Alex Choi
- Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, The Mischer Neuroscience Institute, Memorial Hermann Texas Medical Center, Houston, Texas, USA
| | - Nancy Edwards
- Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, The Mischer Neuroscience Institute, Memorial Hermann Texas Medical Center, Houston, Texas, USA
| | - Tiffany Chang
- Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, The Mischer Neuroscience Institute, Memorial Hermann Texas Medical Center, Houston, Texas, USA
| | - Robert N Sladen
- Division of Critical Care, Department of Anesthesiology, Columbia University Medical Center, New York, USA
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Sakhuja A, Schold JD, Kumar G, Katzan I, Navaneethan SD. Nontraumatic subarachnoid hemorrhage in maintenance dialysis hospitalizations: trends and outcomes. Stroke 2013; 45:71-6. [PMID: 24253541 DOI: 10.1161/strokeaha.113.003012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Subarachnoid hemorrhage (SAH) is associated with high mortality, and patients on maintenance dialysis have been shown to be at higher risk for stroke including SAH. However, the outcomes of patients on maintenance dialysis with SAH are not well known. This study was designed to look at incidence and outcomes of SAH in those on maintenance dialysis. METHODS Using the Nationwide Inpatient Sample Database, hospitalizations with nontraumatic SAH were identified. Age-adjusted incidence rates were calculated by direct standardization to the 2000 US standard population. Logistic regression was used to assess the risk factors for mortality. RESULTS Of an estimated 149,091 hospitalizations with SAH, 1631 patients (10.9%) were on maintenance dialysis. Unadjusted incidence of SAH hospitalizations was higher in maintenance dialysis than in the general population (73.5 versus 11.2 per 100,000 population), and similar results were seen on age-adjusted analysis. The unadjusted all-cause inpatient mortality rate for SAH admissions was higher in maintenance dialysis versus the general population (38.4% versus 21.9%; P<0.001). Maintenance dialysis was an independent predictor of mortality (odds ratio, 2.48; 95% confidence interval, 1.85-3.34), although other significant predictors of mortality were similar in both subgroups. Incidence of SAH hospitalizations has been relatively stable during the study period, but mortality seems to be decreasing. CONCLUSIONS SAH hospitalizations are more common and associated with higher mortality in patients on maintenance dialysis than in the general population. Although being on maintenance dialysis is an independent predictor for mortality in patients with SAH, other predictors of mortality evaluated in this study are not necessarily different between the 2 groups.
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Affiliation(s)
- Ankit Sakhuja
- From the Departments of Nephrology and Hypertension (A.S., J.D.S., S.D.N.), Quantitative Health Sciences (J.D.S.), and Neurology (I.K.), Cleveland Clinic, Cleveland, OH; and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee (G.K.)
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Johansson I, Nilsson LM, Stegmayr B, Boman K, Hallmans G, Winkvist A. Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden. Nutr J 2012; 11:40. [PMID: 22686621 PMCID: PMC3489616 DOI: 10.1186/1475-2891-11-40] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 05/01/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In the 1970s, men in northern Sweden had among the highest prevalences of cardiovascular diseases (CVD) worldwide. An intervention program combining population- and individual-oriented activities was initiated in 1985. Concurrently, collection of information on medical risk factors, lifestyle and anthropometry started. Today, these data make up one of the largest databases in the world on diet intake in a population-based sample, both in terms of sample size and follow-up period. The study examines trends in food and nutrient intake, serum cholesterol and body mass index (BMI) from 1986 to 2010 in northern Sweden. METHODS Cross-sectional information on self-reported food and nutrient intake and measured body weight, height, and serum cholesterol were compiled for over 140,000 observations. Trends and trend breaks over the 25-year period were evaluated for energy-providing nutrients, foods contributing to fat intake, serum cholesterol and BMI. RESULTS Reported intake of fat exhibited two significant trend breaks in both sexes: a decrease between 1986 and 1992 and an increase from 2002 (women) or 2004 (men). A reverse trend was noted for carbohydrates, whereas protein intake remained unchanged during the 25-year period. Significant trend breaks in intake of foods contributing to total fat intake were seen. Reported intake of wine increased sharply for both sexes (more so for women) and export beer increased for men. BMI increased continuously for both sexes, whereas serum cholesterol levels decreased during 1986 - 2004, remained unchanged until 2007 and then began to rise. The increase in serum cholesterol coincided with the increase in fat intake, especially with intake of saturated fat and fats for spreading on bread and cooking. CONCLUSIONS Men and women in northern Sweden decreased their reported fat intake in the first 7 years (1986-1992) of an intervention program. After 2004 fat intake increased sharply for both genders, which coincided with introduction of a positive media support for low carbohydrate-high-fat (LCHF) diet. The decrease and following increase in cholesterol levels occurred simultaneously with the time trends in food selection, whereas a constant increase in BMI remained unaltered. These changes in risk factors may have important effects on primary and secondary prevention of cardiovascular disease (CVD).
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Affiliation(s)
| | - Lena Maria Nilsson
- Department of Public Health and Clinical Medicine section of nutrition, Umeå University, Umeå, Sweden
| | | | - Kurt Boman
- Department of Public Health and Clinical Medicine section of nutrition, Umeå University, Umeå, Sweden
- Department of Medicine, Skellefteå County Hospital, Skellefteå, Sweden
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine section of nutrition, Umeå University, Umeå, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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