Joint effect of modifiable risk factors on the risk of aneurysmal subarachnoid hemorrhage

A cohort study

Haakon Lindekleiv*, Marie S. Sandvei, Pål R. Romundstad, Tom Wilsgaard, Inger Njølstad, Tor Ingebrigtsen, Anne Vik, Ellisiv B. Mathiesen

*Corresponding author for this work

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background and Purpose-The joint effect of risk factors on the risk of aneurysmal SAH (aSAH) has been studied sparsely. Methods-We examined the potential synergism between cigarette smoking, hypertension, and regular alcohol consumption and the risk of aSAH in a prospective, population-based cohort of participants from the Nord-Trøndelag Health Study and the Tromsø Study in Norway. Interaction was assessed on additive and multiplicative scales. Results-We identified 122 cases of aSAH over 977 895 person-years of follow-up. Interaction was observed between current smoking and hypertension on the additive scale, (relative excess risk because of interaction, 6.40; 95% CI, 0.88-11.92, adjusted for sex and age). We found no significant interaction between hypertension and regular alcohol consumption or current cigarette smoking and regular alcohol consumption on the additive scale. No significant interaction was detected on the multiplicative scale. Conclusions-The joint effect of current smoking and hypertension on the risk of aSAH was stronger than was the sum of the independent effects of each factor. Persons at risk of aSAH should be advised of a markedly stronger risk for aSAH with the combination of current smoking and hypertension. In addition, the finding suggests that combining smoking cessation and blood pressure lowering may have an extra risk reduction effect on preventing aSAH.

Original languageEnglish
Pages (from-to)1885-1889
Number of pages5
JournalStroke
Volume43
Issue number7
DOIs
Publication statusPublished - Jul 2012
Externally publishedYes

Keywords

  • risk factors
  • subarachnoid hemorrhage

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    Lindekleiv, H., Sandvei, M. S., Romundstad, P. R., Wilsgaard, T., Njølstad, I., Ingebrigtsen, T., ... Mathiesen, E. B. (2012). Joint effect of modifiable risk factors on the risk of aneurysmal subarachnoid hemorrhage: A cohort study. Stroke, 43(7), 1885-1889. https://doi.org/10.1161/STROKEAHA.112.651315