By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.

SOURCE: Lindbohm JV, Kaprio J, Jousilahti P, et al. Risk factors of sudden death from subarachnoid hemorrhage. Stroke 2017;48:2399-2404.

Based on recent nationwide data reported from Finland, one-fourth of those experiencing their first ever subarachnoid hemorrhage (SAH) died suddenly before being admitted to a hospital. Most epidemiological studies have been based on hospitalized patients, and in prospective, long-term studies, the significant risk factors for SAH have included smoking, high blood pressure, female gender, and increasing age. However, risk factors that result in early sudden death have not been analyzed systematically. In this study from Finland, a cohort of 65,521 individuals was followed for up to 1.5 million person-years, and Cox proportional hazards were used to calculate hazard ratios for all SAH risk factors, as well as socioeconomic status. A risk model analyzed differences in risk factors between hospitalized patients with SAH and those who had sudden prehospital death from SAH (autopsy proved).

From this cohort, the investigators identified 98 sudden-death SAH patients and 445 hospitalized SAH patients. Increased consumption of cigarettes of > 5 per day elevated sudden death SAH risk (hazard ratio [HR], 1.28) more than hospitalized SAH. A higher systolic blood pressure also was a risk factor for sudden death from SAH (HR, 1.34). Study patients living alone were at elevated risk for sudden death from SAH (HR, 2.09). There were no incidents of sudden death from SAH patients who were known to be normotensive, never smoked, and were younger than 50 years of age. Sudden death from SAH appears to be highest among those with the most adverse risk factor profile and those who lived alone. Younger patients, under the age of 50, who had normal blood pressure and had never smoked, had a low risk for sudden death from SAH.