Smokers with Intracranial Aneurysms Who Underwent Neurosurgical or Endovascular Treatment Have Not Stopped Smoking One Year after Surgery

By Zvolská, Kamila; Králíková, Eva et al. | Central European Journal of Public Health, March 2012 | Go to article overview

Smokers with Intracranial Aneurysms Who Underwent Neurosurgical or Endovascular Treatment Have Not Stopped Smoking One Year after Surgery


Zvolská, Kamila, Králíková, Eva, Benes, Vladimír, Koblihová, Jana, Rames, Jirí, Netuka, David, Central European Journal of Public Health


SUMMARY

Smoking increases the risk of forming, growing, and rupture of intracranial aneurysms. We retrospectively reviewed patients with intracranial aneurysms treated by neurosurgical or endovascular treatment - 154 patients (45 men, 109 women, 15 to 62 years, average 46.3 years, CI±1.72). We found 74% (114/154) of smokers - 80% (36/45) men and 71.6% (78/109) women, with the mean value of the Fagerström Test of Nicotine Dependence 4.4 (CI±0.40). The average age of smoking initiation was 18.2 years (CI±0.66), the average period of smoking 26.8 years (CI±2.13). The average number of cigarettes consumed daily was 18.2 (CI±1.58). With statistical significance p<0.05, the athero-index was lower in nonsmokers than smokers: 3.4 (CI±0.56) vs. 4.5 (CI±0.51). HDL cholesterol was higher in non-smokers than smokers: 1.6 mmol/l (CI±0.25) vs. 1.4 (CI±0.10), and triglycerides were higher in smokers than non-smokers: 1.3 mmol/l (CI±0.16) vs. 1.9 (CI±0.35). Forty-two per cent of smokers (48/114) were controlled one year after the treatment; 18.8% of them stopped smoking, 41.7% reduced smoking, and 39.6% continued to smoke as extensively as before. The prevalence of smoking in our sample was higher than in the Czech population (28.2%). Only 18.8% of controlled smokers were able to quit one year after the intervention.

Key words: smoking, smoking cessation, intracranial aneurysm, subarachnoid hemorrhage, Fagerström Test for Nicotine Dependence

INTRODUCTION

An intracranial aneurysm (IA) is a thin walled outpouching or dilatation of the brain artery. It originates in local infliction of the vascular wall by atherosclerosis, trauma, infection (mycotic aneurysms resulting from infected embolic material from a bacterial infection on one of the heart valves), neoplastic disease, and most often by congenital abnormality of the intima with abnormal thinning of the artery (1-3).

Many studies imply that smoking is a very important risk factor in the formation of intracranial aneurysms, with OR from 1 .7 to 3 .48 (4-6) (Table 1). Smoking and possibly also age and female sex seem to be risk factors for multiple intracranial aneurysms (OR of smoking 2. 1 0; 95% CI, 1 .06-4. 13) (7). Cigarette smoking appears to increase the risk for growth of larger aneurysms (see e.g. the studies of The Department of Neurosurgery, University at Buffalo and University of Colorado in Denver). Smoking (OR 2.2; 95% CI, 1.1-4.5) and middle cerebral artery origin (OR 2.5; 95% CI, 1.3-4.9) seem to increase the risk of developing large aneurysms (6).

Smoking has also been proved to increase the risk of I A rupture (OR from 2.2 to 4.1 for former smokers, 5.4 for current smokers, respectively) that leads to subarachnoid hemorrhage (SAH) (6, 8, 9, 10) (Table 1). Hypotheses explaining the effects of smoking on IA rupture include enhanced systematic coagulability, inflammation within arterial walls, increased blood pressure, endothelial dysfunction, and the promotion of degradation of elastin within vessel walls by interfering with alfa 1 -antitrypsin (6, 11). Arterial hypertension is also a significant independent risk factor for aneurysmal SAH, OR from 24 to 6.8 (8, 9, 10, 12) (Table 1).

With regard to the minimal symptomatology of intracranial aneurysms, it is very important to support a healthy life style involving non-smoking. Cigarette smoking is the most important preventable cause of SAH, with a strong dose-response relationship having been shown in many studies. After smoking cessation the risk of aneurysmal rupture declines (11).

In the Czech Republic, with 10,429,692 inhabitants (13), the prevalence of smoking is 28.2% in the population older than 15 years (30.3% in men and 25.9% in women) (14).

This study does not seek to prove that smoking causes intracranial aneurysms. It addresses the resistance of our study sample to smoking cessation. We wanted to assess a sample of patients with diagnoses of intracranial aneurysms, find out the prevalence of smoking among these patients, and check their smoking status after one year. …

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