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Evidence for smoking, insomnia as modifiable risk factors for intracranial aneurysm, hemorrhage

Journal
Journal of the American Heart Association
Reuters Health - 22/11/2021 - Modifiable risk factors with the strongest link to intracranial aneurysm and aneurysmal subarachnoid hemorrhage include smoking, insomnia, and elevated diastolic blood pressure, a Mendelian randomization study suggests.

Researchers examined genetic information from a meta-analysis conducted by the International Stroke Genetics Consortium that included data on 6,252 intracranial aneurysm cases and 4,196 aneurysmal subarachnoid hemorrhage cases; they compared these cases to 59,544 controls.

The analysis focused on genetic variants predicting lifestyle risk factors including smoking, coffee consumption, sleep, and physical activity, as well as cardiometabolic factors including body mass index, glycemic traits, type 2 diabetes, systolic and diastolic blood pressure, lipids, inflammation and kidney function markers. The goal was to determine which of these genetically-predicted risk factors were associated with ruptured or unruptured intracranial aneurysm and aneurysmal subarachnoid hemorrhage.

People with a genetic predisposition to smoking, insomnia, and higher blood pressure had a significantly higher risk of both intracranial aneurysm and aneurysmal subarachnoid hemorrhage, the study team reports in the Journal of the American Heart Association.

"The strongest and most consistent associations were for smoking and high blood pressure," said senior study author Susanna Larsson of Uppsala University and Karolinska Institute in Stockholm, Sweden.

"These associations have been reported in previous studies, and our results now provide further strong support that these are the most important risk factors for intracranial aneurysm and aneurysmal subarachnoid hemorrhage," Larsson said by email. "The association for insomnia was novel and somewhat surprising - this association needs to be confirmed by future studies."

Smoking was significantly associated with both intracranial aneurysm (odds ratio 3.20 for each SD increase in smoking) and aneurysmal subarachnoid hemorrhage (OR 2.99 for each SD increase in smoking). Smoking initiation was also significantly associated with both intracranial aneurysm (OR 1.85) and aneurysmal subarachnoid hemorrhage (OR 1.62).

Insomnia was also significantly associated with intracranial aneurysm (OR 1.24) and aneurysmal subarachnoid hemorrhage (OR 1.20).

In addition, each 10 mmHg increase in diastolic blood pressure was significantly associated with intracranial aneurysm (OR 2.92) and aneurysmal subarachnoid hemorrhage (OR 3.21).

High triglyceride levels and high BMI were not associated with increased risk.

One limitation of the study is that researchers lacked sufficient data to analyze certain risk factors. Results from a population of predominantly European ancestry also may not be representative of people with other backgrounds.

"The take-home message is that it's very important to check and control blood pressure if above normal levels and to never initiate smoking and that smokers quit as soon as possible," Larsson said. "A high blood pressure and smoking are not only strong risk factors for intracranial aneurysm and aneurysmal subarachnoid hemorrhage but also other vascular diseases."

SOURCE: https://bit.ly/3kZN2CK Journal of the American Heart Association, online November 3, 2021.

By Lisa Rapaport



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