Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane, Japan

Abstract 

Background

Prevention of aneurysmal subarachnoid hemorrhage (SAH) can be achieved by reducing risk factors, which include those for aneurysm formation and aneurysm rupture. However, neither of these 2 factors has been discussed separately so far. A case control study was undertaken in Shimane, Japan, to identify modifiable risk factors for the formation and rupture of aneurysms.

Methods

This study included 858 patients with ruptured aneurysms, 285 patients with unruptured aneurysms without a history of SAH, and 798 control subjects. Hypertension, diabetes mellitus, heart disease, hypercholesterolemia, cigarette smoking, and alcohol consumption were assessed as risk factors by using conditional logistic regression.

Results

After adjustment for other risk factors, hypertension was the most powerful risk factor for aneurysm formation, regardless of age and sex, followed by hypercholesterolemia, heart disease, and cigarette smoking, whereas diabetes mellitus and daily drinking were insignificant for aneurysm formation. Hypertension and daily drinking were not related to the risk of aneurysm rupture, regardless of age and sex, whereas cigarette smoking was associated with an increased risk of aneurysm rupture in patients 60 years or older and in men. In contrast, hypercholesterolemia was strongly associated with a decreased risk of rupture, regardless of age and sex, and in patients with small aneurysms (<5 mm). Diabetes mellitus and heart disease were also related to a decreased risk of rupture in patients 60 years or older and in women.

Conclusion

Identification of risk factors for aneurysm formation and rupture separately seems to be pivotal for reducing the incidence of SAH.

Abbreviations: ACA, anterior cerebral artery, BP, blood pressure, CI, confidence interval, CT, computed tomography, ICA, internal carotid artery, MCA, middle cerebral artery, MRA, magnetic resonance angiography, OR, odds ratio, SAH, subarachnoid hemorrhage, VBA, vertebrobasilar artery

Keywords: Aneurysm formation, Aneurysm rupture, Risk factors, Subarachnoid hemorrhage, Unruptured aneurysm