Sex, Smoking, and Risk for Subarachnoid Hemorrhage
Women are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among prospective studies. We studied associations between smoking habits and SAH and interactions between known SAH risk factors in a prospective populatio...
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| Published in: | Stroke (1970) Vol. 47; no. 8; pp. 1975 - 1981 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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01.08.2016
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| ISSN: | 1524-4628 |
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| Abstract | Women are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among prospective studies. We studied associations between smoking habits and SAH and interactions between known SAH risk factors in a prospective population-based study.
The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.38 million person-years. We used the Cox proportional hazards model to calculate hazard ratios and evaluated additive and multiplicative interactions between study variables, with all analyses adjusted for known SAH risk factors.
During follow-up, we identified 492 SAHs (266 women). Smoking had a linear dose-dependent and cumulative association with risk for SAH in both sexes. Women smoking >20 cigarettes per day had a hazard ratio of 8.35 (95% confidence interval, 3.86-18.06) compared with a hazard ratio of 2.76 (95% confidence interval, 1.68-4.52) in men in the same cigarettes per day group. Hazard ratios differed by sex in all cigarettes per day and pack-year categories; this association was stronger in women in all categories (P=0.01). When an adjusted model included interaction terms between sex and cigarettes per day or pack-years, female sex was no longer an independent SAH risk factor. Former smokers had a markedly decreased risk for SAH in both sexes when compared with current smokers.
Smoking has a dose-dependent and cumulative association with SAH risk, and this risk is highest in female heavy smokers. Vulnerability to smoking seems to explain in part the increased SAH risk in women. |
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| AbstractList | Women are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among prospective studies. We studied associations between smoking habits and SAH and interactions between known SAH risk factors in a prospective population-based study.
The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.38 million person-years. We used the Cox proportional hazards model to calculate hazard ratios and evaluated additive and multiplicative interactions between study variables, with all analyses adjusted for known SAH risk factors.
During follow-up, we identified 492 SAHs (266 women). Smoking had a linear dose-dependent and cumulative association with risk for SAH in both sexes. Women smoking >20 cigarettes per day had a hazard ratio of 8.35 (95% confidence interval, 3.86-18.06) compared with a hazard ratio of 2.76 (95% confidence interval, 1.68-4.52) in men in the same cigarettes per day group. Hazard ratios differed by sex in all cigarettes per day and pack-year categories; this association was stronger in women in all categories (P=0.01). When an adjusted model included interaction terms between sex and cigarettes per day or pack-years, female sex was no longer an independent SAH risk factor. Former smokers had a markedly decreased risk for SAH in both sexes when compared with current smokers.
Smoking has a dose-dependent and cumulative association with SAH risk, and this risk is highest in female heavy smokers. Vulnerability to smoking seems to explain in part the increased SAH risk in women. BACKGROUND AND PURPOSEWomen are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among prospective studies. We studied associations between smoking habits and SAH and interactions between known SAH risk factors in a prospective population-based study.METHODSThe population-based FINRISK study cohort of 65 521 individuals was followed up for 1.38 million person-years. We used the Cox proportional hazards model to calculate hazard ratios and evaluated additive and multiplicative interactions between study variables, with all analyses adjusted for known SAH risk factors.RESULTSDuring follow-up, we identified 492 SAHs (266 women). Smoking had a linear dose-dependent and cumulative association with risk for SAH in both sexes. Women smoking >20 cigarettes per day had a hazard ratio of 8.35 (95% confidence interval, 3.86-18.06) compared with a hazard ratio of 2.76 (95% confidence interval, 1.68-4.52) in men in the same cigarettes per day group. Hazard ratios differed by sex in all cigarettes per day and pack-year categories; this association was stronger in women in all categories (P=0.01). When an adjusted model included interaction terms between sex and cigarettes per day or pack-years, female sex was no longer an independent SAH risk factor. Former smokers had a markedly decreased risk for SAH in both sexes when compared with current smokers.CONCLUSIONSSmoking has a dose-dependent and cumulative association with SAH risk, and this risk is highest in female heavy smokers. Vulnerability to smoking seems to explain in part the increased SAH risk in women. |
| Author | Lindbohm, Joni Valdemar Korja, Miikka Salomaa, Veikko Kaprio, Jaakko Jousilahti, Pekka |
| Author_xml | – sequence: 1 givenname: Joni Valdemar surname: Lindbohm fullname: Lindbohm, Joni Valdemar email: joni.lindbohm@helsinki.fi organization: From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.). joni.lindbohm@helsinki.fi – sequence: 2 givenname: Jaakko surname: Kaprio fullname: Kaprio, Jaakko organization: From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.) – sequence: 3 givenname: Pekka surname: Jousilahti fullname: Jousilahti, Pekka organization: From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.) – sequence: 4 givenname: Veikko surname: Salomaa fullname: Salomaa, Veikko organization: From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.) – sequence: 5 givenname: Miikka surname: Korja fullname: Korja, Miikka organization: From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27444257$$D View this record in MEDLINE/PubMed |
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| Snippet | Women are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among... BACKGROUND AND PURPOSEWomen are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been... |
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| SubjectTerms | Adult Aged Female Finland - epidemiology Follow-Up Studies Humans Incidence Male Middle Aged Prospective Studies Risk Factors Sex Factors Smoking - adverse effects Subarachnoid Hemorrhage - epidemiology Subarachnoid Hemorrhage - etiology |
| Title | Sex, Smoking, and Risk for Subarachnoid Hemorrhage |
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