Risk Factors for Aneurysmal Subarachnoid Hemorrhage in an Indian Population

Koshy, Linda; Easwer, H. V.; Premkumar, S.; Alapatt, Jacob Paul; Pillai, Avinesh; Nair, Suresh; Bhattacharya, R. N.; Banerjee, Moinak

doi:10.1159/000275501

Cited by 32 publications

(28 citation statements)

References 32 publications

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“…Instead, the association between type 2 diabetes and sIA disease has remained unclear. Unlike our study and the cohort of 329 cases of SAH from sIA published in 1984 (37), three recent studies (20–22) and our present review of the literature from the six published ones suggested that diabetes is a protective factor for SAH (Table 1; Fig. 1).…”

Section: Discussioncontrasting

confidence: 78%

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Type 2 Diabetes and Risk of Rupture of Saccular Intracranial Aneurysm in Eastern Finland

et al. 2013

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OBJECTIVEType 2 diabetes is a risk factor for other forms of stroke, but its association with subarachnoid hemorrhage (SAH) from ruptured saccular intracranial aneurysm (sIA) has remained unclear.RESEARCH DESIGN AND METHODSKuopio Intracranial Aneurysm Database (www.uef.fi/ns) includes all ruptured and unruptured sIA cases from a defined catchment population in eastern Finland since 1980. We compared the age-adjusted incidences of type 2 diabetes in 1,058 ruptured and 484 unruptured sIA patients during 1994–2008, using the national registry of prescribed medicine purchases.RESULTSOf the 1,058 ruptured sIA patients, 43% were males and 57% females, with a median age at rupture of 51 and 56 years, respectively. From 1994 to 2008 or until death, 9% had been prescribed antidiabetes medication (ADM) with a median starting age of 58 years for males and 66 years for females. Of the 484 unruptured sIA patients, 44% were males and 56% females, with a median age at the diagnosis of 53 and 55 years, respectively, and 9% had used ADM, with a median starting age of 61 years for males and 66 years for females. The incidence of type 2 diabetes was highest in the age-group 60–70 years, with no significant differences between the ruptured and unruptured sIA patients.CONCLUSIONSOur study suggests that type 2 diabetes does not increase the risk of rupture of sIA, which is by far the most frequent cause of nontraumatic SAH.

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Section: Discussioncontrasting

confidence: 78%

“…Instead, the association between type 2 diabetes and sIA disease has remained unclear. Three recent studies (20–22) and our present review of the literature suggest that diabetes is a protecting factor for rupture of sIA (Table 1; Fig. 1 A ) (23–29).…”

mentioning

confidence: 51%

Type 2 Diabetes and Risk of Rupture of Saccular Intracranial Aneurysm in Eastern Finland

et al. 2013

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“…The extremely low incidence rate invalidates a routine screen. However, in taking care of patients with lupus, one should aggressively control lupus activity and other well‐established risk factors of SAH, including hypertension, bleeding tendency, and cigarette smoking (22). Furthermore, in SLE patients with severe headache, despite a relatively young age, SAH should be suspected as an important differential diagnosis, especially in those with higher lupus activity or a history of recurrent platelet or red blood cell transfusion.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Subarachnoid Hemorrhage in Patients With Systemic Lupus Erythematosus: A Nationwide Population‐Based Study

Chang

Liu

Chen

et al. 2013

Arthritis Care & Research

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Objective. A relatively common occurrence of spontaneous subarachnoid hemorrhage (SAH) in patients with systemic lupus erythematosus (SLE) has been noted; however, the subsequent studies were conflicting. This nationwide populationbased study aimed to evaluate the risk of SAH in patients with SLE. Methods. We identified 16,967 SLE patients from the Taiwan National Health Insurance (NHI) database between 2000 and 2006, and compared the incidence rate of SAH with 16,967 randomly selected age-and sex-matched non-SLE subjects. A Cox multivariable proportional hazards model was used to evaluate the risk factors of SAH in the SLE cohort. Results. The SLE cohort had a higher risk of SAH, with an incidence rate ratio of 4.84 (P < 0.001). Despite a younger age, the mortality rate after SAH was significantly higher in the SLE cohort compared to all of the non-SLE SAH patients identified from the 1 million NHI beneficiaries (60.0% versus 38.9%; P ‫؍‬ 0. Conclusion. This study demonstrated that SAH is a rare but associated complication of SLE with a high mortality rate. Other than age, higher mean daily steroid use and a history of platelet or red blood cell transfusion were associated with the occurrence of SAH in patients with SLE.

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“…Smoking causes direct injury to endothelial cells [16], oxidation of low-density lipoprotein[17], and acceleration of thrombus formation through increased plasma fibrinogen [18], increased platelet aggregability [19] and decreased fibrinolytic activity [20], all of which are associated with the development of atherosclerotic diseases such as ischemic stroke and CHD. Smoking is also considered to cause the formation, growth and rupture of intracranial aneurysms [21,22], probably due to an elastase/α 2 -antitrypsin imbalance in the artery wall [23], leading to an elevated risk of subarachnoid hemorrhage [21,22,24]. …”

Section: Discussionmentioning

confidence: 99%

Combined Effects of Smoking and Hypercholesterolemia on the Risk of Stroke and Coronary Heart Disease in Japanese: The Hisayama Study

et al. 2011

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Background: Cigarette smoking is an established risk factor for stroke and coronary heart disease (CHD) in Western countries. However, it is uncertain whether or not smoking raises the risk of stroke in Japanese. We examined the influence of smoking on the development of stroke and CHD and the effects of interactions between smoking and hypercholesterolemia on these outcomes in a general Japanese population. Methods: A total of 2,421 community-dwelling Japanese individuals, aged 40–79 years, with no history of cardiovascular disease, were followed up for 14 years. Results: During the follow-up, 194 total stroke and 112 CHD events occurred. Compared with never smokers, the multivariate-adjusted hazard ratios for the occurrence of total stroke were 1.53 (95% confidence interval = 0.90–2.61) in former smokers, 1.90 (1.18–3.06) in current light smokers (<20 cigarettes/day) and 2.01 (1.11–3.65) in current heavy smokers (≧20 cigarettes/day). The multivariate-adjusted hazard ratios for the development of CHD were 1.10 (0.56–2.15), 1.88 (1.02–3.47) and 2.31 (1.17–4.57), respectively. In regard to stroke subtypes, current smoking was an independently significant risk factor for ischemic stroke and subarachnoid hemorrhage. Furthermore, the combination of smoking and hypercholesterolemia synergistically increased the risks of total stroke and CHD (all p for interaction <0.05). Conclusion: Our findings suggest that smoking raises the risks of ischemic stroke, subarachnoid hemorrhage and CHD occurrence in the Japanese population, and that this effect is strengthened by hypercholesterolemia.

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Risk Factors for Aneurysmal Subarachnoid Hemorrhage in an Indian Population

Cited by 32 publications

References 32 publications

Type 2 Diabetes and Risk of Rupture of Saccular Intracranial Aneurysm in Eastern Finland

Type 2 Diabetes and Risk of Rupture of Saccular Intracranial Aneurysm in Eastern Finland

Increased Risk of Subarachnoid Hemorrhage in Patients With Systemic Lupus Erythematosus: A Nationwide Population‐Based Study

Combined Effects of Smoking and Hypercholesterolemia on the Risk of Stroke and Coronary Heart Disease in Japanese: The Hisayama Study

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