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September 26, 2017; 89 (13) Article

Association of intracranial aneurysm rupture with smoking duration, intensity, and cessation

Anil Can, Victor M. Castro, Yildirim H. Ozdemir, Sarajune Dagen, Sheng Yu, Dmitriy Dligach, Sean Finan, Vivian Gainer, Nancy A. Shadick, Shawn Murphy, Tianxi Cai, Guergana Savova, Ruben Dammers, Scott T. Weiss, Rose Du
First published August 30, 2017, DOI: https://doi.org/10.1212/WNL.0000000000004419
Anil Can
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Victor M. Castro
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Yildirim H. Ozdemir
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Sarajune Dagen
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Sheng Yu
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Dmitriy Dligach
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Sean Finan
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Vivian Gainer
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Nancy A. Shadick
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Shawn Murphy
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Tianxi Cai
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Guergana Savova
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Ruben Dammers
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Scott T. Weiss
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Rose Du
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
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Full PDF
Citation
Association of intracranial aneurysm rupture with smoking duration, intensity, and cessation
Anil Can, Victor M. Castro, Yildirim H. Ozdemir, Sarajune Dagen, Sheng Yu, Dmitriy Dligach, Sean Finan, Vivian Gainer, Nancy A. Shadick, Shawn Murphy, Tianxi Cai, Guergana Savova, Ruben Dammers, Scott T. Weiss, Rose Du
Neurology Sep 2017, 89 (13) 1408-1415; DOI: 10.1212/WNL.0000000000004419

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Abstract

Objective: Although smoking is a known risk factor for intracranial aneurysm (IA) rupture, the exact relationship between IA rupture and smoking intensity and duration, as well as duration of smoking cessation, remains unknown.

Methods: In this case-control study, we analyzed 4,701 patients with 6,411 IAs diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016. We divided individuals into patients with ruptured aneurysms and controls with unruptured aneurysms. We performed univariable and multivariable logistic regression analyses to determine the association between smoking status and ruptured IAs at presentation. In a subgroup analysis among former and current smokers, we assessed the association between ruptured aneurysms and number of packs per day, duration of smoking, and duration since smoking cessation.

Results: In multivariable analysis, current (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.89–2.59) and former smoking status (OR 1.56, 95% CI 1.31–1.86) were associated with rupture status at presentation compared with never smokers. In a subgroup analysis among current and former smokers, years smoked (OR 1.02, 95% CI 1.01–1.03) and packs per day (OR 1.46, 95% CI 1.25–1.70) were significantly associated with ruptured aneurysms at presentation, whereas duration since cessation among former smokers was not significant (OR 1.00, 95% CI 0.99–1.02).

Conclusions: Current cigarette smoking, smoking intensity, and smoking duration are significantly associated with ruptured IAs at presentation. However, the significantly increased risk persists after smoking cessation, and smoking cessation does not confer a reduced risk of aneurysmal subarachnoid hemorrhage beyond that of reducing the cumulative dose.

GLOSSARY

aSAH=
aneurysmal subarachnoid hemorrhage;
BWH=
Brigham and Women's Hospital;
CI=
confidence interval;
IA=
intracranial aneurysm;
ICD-9=
International Classification of Diseases–9;
MGH=
Massachusetts General Hospital;
NLP=
natural language processing;
OR=
odds ratio;
RPDR=
Partners Healthcare Research Patients Data Registry;
SAH=
subarachnoid hemorrhage

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Editorial, page 1320

  • Received February 14, 2017.
  • Accepted in final form June 26, 2017.
  • © 2017 American Academy of Neurology
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