Cigarette smoking and risk of intracranial aneurysms in middle-aged women

Authors

Christopher S. Ogilvy, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA cogilvy@bidmc.harvard.edu.
Santiago Gomez-Paz, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Kimberly P. Kicielinski, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Mohamed M. Salem, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Yosuke Akamatsu, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.Follow
Muhammad Waqas, Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States.
Hamid Hussain Rai, Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.Follow
Sandeep Muram, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada.
Mohammed Elghareeb, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States.
Adnan H. Siddiqui, Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, United States.
Elad I. Levy, Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, United States.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.Follow
Alim P. Mitha, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada.
Brian L. Hoh, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States.
Adam Polifka, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States.
W Christopher Fox, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States.
Justin M. Moore, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Ajith J. Thomas, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: We previously reported a single-centre study demonstrating that smoking confers a six-fold increased risk for having an unruptured intracranial aneurysm (UIA) in women aged between 30 and 60 years and this risk was higher if the patient had chronic hypertension. There are no data with greater generalisability evaluating this association. We aimed to validate our previous findings in women from a multicentre study. METHODS: A multicentre case-control study on women aged between 30 and 60 years, that had magnetic resonance angiography (MRA) during the period 2016-2018. Cases were those with an incidental UIA, and these were matched to controls based on age and ethnicity. A multivariable conditional logistic regression was conducted to evaluate smoking status and hypertension differences between cases and controls. RESULTS: From 545 eligible patients, 113 aneurysm patients were matched to 113 controls. The most common reason for imaging was due to chronic headaches in 62.5% of cases and 44.3% of controls. A positive smoking history was encountered in 57.5% of cases and in 37.2% of controls. A multivariable analysis demonstrated a significant association between positive smoking history (OR 3.7, 95%CI 1.61 to 8.50), hypertension (OR 3.16, 95% CI 1.17 to 8.52) and both factors combined with a diagnosis of an incidental UIA (OR 6.9, 95% CI 2.49 to 19.24). CONCLUSIONS: Women aged between 30 and 60 years with a positive smoking history have a four-fold increased risk for having an UIA, and a seven-fold increased risk if they have underlying chronic hypertension. These findings indicate that women aged between 30 and 60 years with a positive smoking history might benefit from a screening recommendation.

Medical Subject Headings

Adult; Canada (epidemiology); Case-Control Studies; Cigarette Smoking (epidemiology); Comorbidity; Female; Humans; Hypertension (epidemiology); Intracranial Aneurysm (epidemiology); Magnetic Resonance Angiography; Middle Aged; United States (epidemiology)

Publication Date

7-30-2020

Publication Title

Journal of neurology, neurosurgery, and psychiatry

E-ISSN

1468-330X

Volume

91

Issue

9

First Page

985

Last Page

990

PubMed ID

32723730

Digital Object Identifier (DOI)

10.1136/jnnp-2020-323753

Recommended Citation

Ogilvy, Christopher S.; Gomez-Paz, Santiago; Kicielinski, Kimberly P.; Salem, Mohamed M.; Akamatsu, Yosuke; Waqas, Muhammad; Rai, Hamid Hussain; Catapano, Joshua S.; Muram, Sandeep; Elghareeb, Mohammed; Siddiqui, Adnan H.; Levy, Elad I.; Lawton, Michael T.; Mitha, Alim P.; Hoh, Brian L.; Polifka, Adam; Fox, W Christopher; Moore, Justin M.; and Thomas, Ajith J., "Cigarette smoking and risk of intracranial aneurysms in middle-aged women" (2020). Neurosurgery. 1383.
https://scholar.barrowneuro.org/neurosurgery/1383