Prospektive Kohortenstudie über die Rolle der Rauchmenge für das Risiko der Entstehung und Ruptur von intrakraniellen Aneurysmen

Along with arterial hypertension, smoking is an acknowledged modifiable risk factor for development and rupture of intracranial aneurysms (IA). However, quantitative data on the impact of smoking on IA genesis is sparse. In this long-term prospective observational cohort study, we analyzed the association between the lifetime and current smoking exposure and IA characteristics.

When including in the study, patients or next of kin filled the questionnaire for quantitative assessment of smoking exposure including the status (no/ex/active) and, if applicable, current (heavy/lite smoker=

In the final cohort (n=986), the distribution of no, ex-, lite, and heavy smokers was 23.2%, 25.6%, 11.2% and 40% respectively. The smoking exposure history in the cohort was median 20 pack-years (IQR: 0.9-35). Current smokers were at higher risk to present with ruptured (aOR=1.71, 95% CI=1.29-2.26, p<0.0001), large (>7mm, aOR=1.41, 95% CI=1.05-1.89, p=0.022) and multiple IA (aOR=1.34, 95% CI=1.01-1.77, p=0.045) than ex- or no smokers. As compared to lite smoking, heavy smoking additionally increased the risk of IA rupture (aOR=1.83, 95% CI=1.33-2.50, p<0.0001) and larger size (aOR=1.65, 95% CI=1.19-2.30, p=0.003). Finally, longer history of smoking (>20 pack-years) was related to higher probability of multiple (aOR=1.61, 95% CI=1.21-2.13, p=0.001) and large IA (aOR=1.40, 95% CI=1.04-1.87, p=0.025).

Our data underline the role of tobacco consumption for IA genesis, and the importance of smoking cessation for rupture prevention. Uninterrupted and heavy smoking particularly increases the risk of IA rupture, whereas the chronic exposure over years more likely results in development of multiple and large IA.