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Abstract & Commentary
Synopsis: The association of caffeine and nicotine in pharmaceutical products and aneurysmal SAH warrants further study.
Source: Broderick JP, et al. Stroke. 2003;34:1375-1381.
Subarachnoid hemorrhage (SAH) due to a ruptured cerebral aneurysm is a disorder that is without apparent cause and is generally impossible to predict. This study suggests that there are a number of SAH risk factors related to lifestyle that are, in fact, modifiable.
The Hemorrhagic Stroke Project (HSP) compared 312 cases of aneurysmal SAH with 618 controls, without SAH, matched for age, sex, and race. Among cases, 66% were cigarette smokers compared with 30% of controls (generating an adjusted odds ratio of 3.73). Cocaine use was identified among 3% of cases and no controls (OR = 25). Other independent risk factors included hypertension, low body mass index, family history, low educational achievement, and caffeine or nicotine in pharmaceutical products.
Comment by Alan Z. Segal, MD
These data from the HSP are important in that they emphasize that a seemingly unavoidable event, a spontaneous aneurysm rupture, may be influenced by modifiable lifestyle factors. While certain risk factors, such as family history or educational level, are difficult or impossible to change, other factors are associated with harmful behaviors and habits. Despite links with both atherosclerotic disease and cancer, young people continue to smoke cigarettes. These data, among individuals aged 18-49, further emphasize additional unrecognized deleterious effects of tobacco use. Similarly, for hypertension, the importance of treating blood pressure to prevent heart disease and stroke is well appreciated. This study further suggests that untreated hypertension in young people may also put them at increased risk for SAH.
Dr. Segal is Assistant Professor, Department of Neurology, Weill-Cornell Medical College, Attending Neurologist, New York Presbyterian Hospital, New York, NY.