Risk Factors of Sudden Death From Subarachnoid Hemorrhage
One in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We studied the differences in risk factors between hospitalized SAH and sudden-death SAH patients. The population-based FINRISK study cohort of 65 52...
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| Published in: | Stroke (1970) Vol. 48; no. 9; p. 2399 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
01.09.2017
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| ISSN: | 1524-4628, 1524-4628 |
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| Abstract | One in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We studied the differences in risk factors between hospitalized SAH and sudden-death SAH patients.
The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.52 million person-years. The Cox proportional hazards model calculated hazard ratios (HRs), with all analyses adjusted for known SAH risk factors, marital status, and socioeconomic status. A competing risks model analyzed differences in risk factors between hospitalized SAHs and sudden-death SAHs.
We identified 98 sudden-death SAHs and 445 hospitalized SAHs confirmed by autopsy or by standard SAH diagnostics. Increase by 5 cigarettes smoked per day elevated sudden-death SAH risk (HR, 1.28; 95% confidence interval [CI], 1.17-1.39) more than hospitalized SAH risk (HR, 1.19; 95% CI, 1.13-1.24;
=0.05 for difference). Per SD (21.4 mm Hg) increase, systolic blood pressure elevated risk of sudden-death SAH (HR, 1.34; 95% CI, 1.09-1.65) more than risk for hospitalized SAH (HR, 1.25; (95% CI, 1.12-1.38;
=0.05 for difference). Participants living without a partner were at elevated risk of sudden-death SAH (HR, 2.09; 95% CI, 1.33-3.28) but not of hospitalized SAH. No sudden-death SAHs occurred in normotensive never smokers aged <50 years.
Sudden-death SAH risk seems to be highest among those individuals with the most adverse risk factor profiles and among those who live without a partner, whereas it is rare among normotensive never smokers aged <50 years. |
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| AbstractList | One in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We studied the differences in risk factors between hospitalized SAH and sudden-death SAH patients.
The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.52 million person-years. The Cox proportional hazards model calculated hazard ratios (HRs), with all analyses adjusted for known SAH risk factors, marital status, and socioeconomic status. A competing risks model analyzed differences in risk factors between hospitalized SAHs and sudden-death SAHs.
We identified 98 sudden-death SAHs and 445 hospitalized SAHs confirmed by autopsy or by standard SAH diagnostics. Increase by 5 cigarettes smoked per day elevated sudden-death SAH risk (HR, 1.28; 95% confidence interval [CI], 1.17-1.39) more than hospitalized SAH risk (HR, 1.19; 95% CI, 1.13-1.24;
=0.05 for difference). Per SD (21.4 mm Hg) increase, systolic blood pressure elevated risk of sudden-death SAH (HR, 1.34; 95% CI, 1.09-1.65) more than risk for hospitalized SAH (HR, 1.25; (95% CI, 1.12-1.38;
=0.05 for difference). Participants living without a partner were at elevated risk of sudden-death SAH (HR, 2.09; 95% CI, 1.33-3.28) but not of hospitalized SAH. No sudden-death SAHs occurred in normotensive never smokers aged <50 years.
Sudden-death SAH risk seems to be highest among those individuals with the most adverse risk factor profiles and among those who live without a partner, whereas it is rare among normotensive never smokers aged <50 years. One in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We studied the differences in risk factors between hospitalized SAH and sudden-death SAH patients.BACKGROUND AND PURPOSEOne in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We studied the differences in risk factors between hospitalized SAH and sudden-death SAH patients.The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.52 million person-years. The Cox proportional hazards model calculated hazard ratios (HRs), with all analyses adjusted for known SAH risk factors, marital status, and socioeconomic status. A competing risks model analyzed differences in risk factors between hospitalized SAHs and sudden-death SAHs.METHODSThe population-based FINRISK study cohort of 65 521 individuals was followed up for 1.52 million person-years. The Cox proportional hazards model calculated hazard ratios (HRs), with all analyses adjusted for known SAH risk factors, marital status, and socioeconomic status. A competing risks model analyzed differences in risk factors between hospitalized SAHs and sudden-death SAHs.We identified 98 sudden-death SAHs and 445 hospitalized SAHs confirmed by autopsy or by standard SAH diagnostics. Increase by 5 cigarettes smoked per day elevated sudden-death SAH risk (HR, 1.28; 95% confidence interval [CI], 1.17-1.39) more than hospitalized SAH risk (HR, 1.19; 95% CI, 1.13-1.24; P=0.05 for difference). Per SD (21.4 mm Hg) increase, systolic blood pressure elevated risk of sudden-death SAH (HR, 1.34; 95% CI, 1.09-1.65) more than risk for hospitalized SAH (HR, 1.25; (95% CI, 1.12-1.38; P=0.05 for difference). Participants living without a partner were at elevated risk of sudden-death SAH (HR, 2.09; 95% CI, 1.33-3.28) but not of hospitalized SAH. No sudden-death SAHs occurred in normotensive never smokers aged <50 years.RESULTSWe identified 98 sudden-death SAHs and 445 hospitalized SAHs confirmed by autopsy or by standard SAH diagnostics. Increase by 5 cigarettes smoked per day elevated sudden-death SAH risk (HR, 1.28; 95% confidence interval [CI], 1.17-1.39) more than hospitalized SAH risk (HR, 1.19; 95% CI, 1.13-1.24; P=0.05 for difference). Per SD (21.4 mm Hg) increase, systolic blood pressure elevated risk of sudden-death SAH (HR, 1.34; 95% CI, 1.09-1.65) more than risk for hospitalized SAH (HR, 1.25; (95% CI, 1.12-1.38; P=0.05 for difference). Participants living without a partner were at elevated risk of sudden-death SAH (HR, 2.09; 95% CI, 1.33-3.28) but not of hospitalized SAH. No sudden-death SAHs occurred in normotensive never smokers aged <50 years.Sudden-death SAH risk seems to be highest among those individuals with the most adverse risk factor profiles and among those who live without a partner, whereas it is rare among normotensive never smokers aged <50 years.CONCLUSIONSSudden-death SAH risk seems to be highest among those individuals with the most adverse risk factor profiles and among those who live without a partner, whereas it is rare among normotensive never smokers aged <50 years. |
| 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 (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, 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 (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.) – sequence: 3 givenname: Pekka surname: Jousilahti fullname: Jousilahti, Pekka organization: From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.) – sequence: 4 givenname: Veikko surname: Salomaa fullname: Salomaa, Veikko organization: From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.) – sequence: 5 givenname: Miikka surname: Korja fullname: Korja, Miikka organization: From the Department of Public Health (J.V.L., J.K.) and Department of Neurosurgery, Helsinki University Hospital (J.V.L., M.K.), University of Helsinki, Finland; Institute for Molecular Medicine FIMM, Finland (J.K.); and National Institute for Health and Welfare, Finland (P.J., V.S.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28739833$$D View this record in MEDLINE/PubMed |
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| Snippet | One in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We... |
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| SubjectTerms | Age Factors Aged Blood Pressure Death, Sudden - epidemiology Female Finland - epidemiology Hospitalization Humans Hypertension - epidemiology Male Middle Aged Proportional Hazards Models Residence Characteristics - statistics & numerical data Risk Factors Smoking - epidemiology Subarachnoid Hemorrhage - mortality |
| Title | Risk Factors of Sudden Death From Subarachnoid Hemorrhage |
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