Joni Valdemar Lindbohm1, Jaakko Kaprio2, Pekka Jousilahti2, Veikko Salomaa2, Miikka Korja2. 1. 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. 2. 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.).
Abstract
BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND AND PURPOSE: 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 SAHpatients. METHODS: 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. RESULTS: 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. CONCLUSIONS: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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