Cigarette smoking as a cause of aneurysmal subarachnoid hemorrhage and risk for vasospasm: a report of the Cooperative Aneurysm Study

Abstract

The findings of a significantly increased representation of current cigarette smokers in the study populations and significant association with younger age at the time of SAH and increased incidence of vasospasm concur with recent reports of smoking as a significant risk factor for ruptured aneurysms and subsequent vasospasm.

Risk Factors for Continued Cigarette Use After Subarachnoid Hemorrhage

“…This may explain in part the lower frequency of prior smoking in our SAH population (47%) compared with prior reports (60% to 70%). 12,13 In summary, 37% of patients who smoked before their SAH had resumed smoking 3 months after their hemorrhage. As a first step to help patients quit smoking, we routinely treat all smokers with a transdermal nicotine patch in the hospital and after discharge, which may provide the added benefit of preventing delirium secondary to nicotine withdrawal during the acute phase of the illness.…”

“…Smoking may promote aneurysm growth by triggering reductions in ␣ 1 -antitrypsin activity, an elastase inhibitor that prevents breakdown of elastin and collagen in the cerebral blood vessel walls. [35][36][37] Finally, smoking has also been associated with symptomatic vasospasm after SAH 12 and with the presence of multiple aneurysms. 13 Although heavy alcohol consumption (Ͼ150 g or 12 beverages per week) 2,8,10 and cocaine ingestion may also increase the risk of recurrent SAH, we did not analyze these lifestyle risk factors in detail because of the small number of 3-month survivors who continued their use.…”

“…2,8 -12 Tobacco use is also a risk factor for the formation of multiple 13 and larger 14 aneurysms and therefore may be a risk factor for recurrent SAH after aneurysm repair. 8 Although it is known that up to 60% to 70% of SAH patients smoke cigarettes, 12,13 few studies have examined how many of these patients resume smoking after their hemorrhage or why they return. One study found that the proportion of smokers decreased from 58% before SAH to 30% 4 to 7 years later.…”

Effects of Habitual Cigarette Smoking on Higher Cortical Function in Patients With Unruptured Cerebral Aneurysms.

“…6) Habitual cigarette smoking is one of the risk factors for cardiovascular diseases, cerebral stroke, vasospasm after subarachnoid hemorrhage, and so on. 21,24) Smoking also seems to be a prospective risk factor for incident cognitive impairment. 2) The mechanism by which smoking contributes to such diseases is not clearly understood.…”

Methodologies to assess blood flow in cerebral aneurysms: Current state of research and perspectives

“…Recognized cofactors contributing to intracranial aneurysm growth and risk of rupture are for example hypertension, atherosclerosis, smoking, excessive alcohol consumption and oral contraceptives. Increased risk exists among patients presenting hereditary deficiencies such as hereditary polycystic kidney disease, Ehlers-Danlos syndrome, Marfan syndrome, fibromuscular dysplasia or family history of aneurysm disease [2][3][4], and between 7 to 20% of people who underwent an aneurismal rupture have a relative of first or second degree with a cerebral aneurysm diagnosed [5]. All this indicates that the biology and the resulting life cycle of a specific aneurysm is potentially influenced by a number of factors and coincidences, what allows for comparing the disease with a complex systems, where the variable factors want to be weighed and integrated according to their possibly varying role along the different periods of the aneurysm life cycle, i.e.…”