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(Stroke. 2004;35:633.)
© 2004 American Heart Association, Inc.

Original Contributions

Active and Passive Smoking and the Risk of Subarachnoid Hemorrhage

An International Population-Based Case-Control Study

Craig S. Anderson, PhD, FRACP, FAFPHM; Valery Feigin, MD, MSc, PhD; Derrick Bennett, MSc, PhD, Cstat; Ruey-Bin Lin, BTech; Graeme Hankey, MD, FRACP, FRCP Konrad Jamrozik, DPhil, FAFPHM for the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS) Group

From the Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand (C.S.A., V.F., D.B., R.-B.L.); Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Western Australia (G.H.); and Department of Primary Health Care and General Practice, Imperial College of Science, Technology and Medicine, London, UK, and School of Population Health, University of Western Australia, Perth, Western Australia (K.J.).

Correspondence to Professor Craig Anderson, Clinical Trials Research Unit, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail c.anderson{at}ctru.auckland.ac.nz

Background and Purpose— This study was undertaken to better clarify the risks associated with cigarette smoking and subarachnoid hemorrhage (SAH).

Methods— The study included 432 incident cases of SAH frequency matched to 473 community SAH-free controls to determine dose-dependent associations of active and passive smoking (at home) and smoking cessation with SAH.

Results— Compared with never smokers not exposed to passive smoking, the adjusted odds ratio for SAH among current smokers was 5.0 (95% confidence interval [CI], 3.1 to 8.1); for past smokers, 1.2 (95% CI, 0.8 to 2.0); and for passive smokers, 0.9 (95% CI, 0.6 to 1.5). Current and lifetime exposures showed a clear dose-dependent effect, and risks appeared more prominent in women and for aneurysmal SAH. Approximately 1 in 3 cases of SAH could be attributed to current smoking, but risks decline quickly after smoking cessation, even among heavy smokers.

Conclusions— A strong positive association was found between cigarette smoking and SAH, especially for aneurysmal SAH and women, which is virtually eliminated within a few years of smoking cessation. Large opportunities exist for preventing SAH through smoking avoidance and cessation programs.

Key Words: case-control studies • epidemiology • intracranial aneurysm • smoking • subarachnoid hemorrhage

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