CIGARETTE-SMOKING AS A CAUSE OF ANEURYSMAL SUBARACHNOID HEMORRHAGE AND RISK FOR VASOSPASM - A REPORT OF THE COOPERATIVE-ANEURYSM-STUDY

Object. Cigarette smoking is associated with aneurysmal subarachnoid h emorrhage (SAH) and subsequent vasospasm. The purpose of this study wa s to quantify this association. Methods. Nearly 3500 patients with SAH from North America and Europe have been enrolled in five different mu lticenter, controlled studies coordinated at the Neuroclinical Trials Center of the Virginia Neurological Institute at the University of Vir ginia. Among the prospective data gathered were whether the patient sm oked at the time of their most recent SAH and the evolution of angiogr aphic vasospasm. The rate of smoking in the patients enrolled in the s tudies was compared with the expected rate by using a chi-square stati stic adjusted for age and gender, in the general population in the Uni ted States (U.S.) and Europe. In virtually all age and gender subgroup s, and for the combined populations in the five clinical trials, patie nts with SAH reported current smoking rates 2.5 limes higher than expe cted based on U.S. and European national surveys (p < 0.0001). Cigaret te smoking was also associated with younger age at onset of SAH (5-10 years, p < 0.0001) and increased incidence of clinically confirmed vas ospasm (p < 0.005). Conclusions. The findings of a significantly incre ased representation of current cigarette smokers in the study populati ons and significant association with younger age at the time of SAH an d increased incidence of vasospasm concur with recent reports of smoki ng as a significant risk factor for ruptured aneurysms and subsequent vasospasm.