on June 2, 2005
Published online before print June 2, 2005, doi: 10.1161/01.STR.0000170710.95689.41
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Submitted on February 14, 2005
From the Clinical Trials Research Unit (V.F., V.P., C.M.M.L., A.R.), Department of Medicine and School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand; the Department of Preventive Medicine (I.S.), Yonsei University College of Medicine, Seoul, Korea; The George Institute for International Health (M.W.), University of Sydney, Australia; the School of Population Health (K.J.), University of Queensland, Herston, Australia; and the Department of Health Science (H.U.), Shiga University of Medical Science, Shiga, Japan. * To whom correspondence should be addressed. E-mail: v.feigin{at}ctru.auckland.ac.nz.
Background and Purpose--The cause of subarachnoid hemorrhage (SAH) is poorly understood and there are few large cohort studies of risk factors for SAH. We investigated the risk of SAH mortality and morbidity associated with common cardiovascular risk factors in the Asia-Pacific region and examined whether the strengths of these associations were different in Asian and Australasian (predominantly white) populations. Methods--Cohort studies were identified from Internet electronic databases, searches of proceedings of meetings, and personal communication. Hazard ratios (HRs) for systolic blood pressure (SBP), current smoking, total serum cholesterol, body mass index (BMI), and alcohol drinking were calculated from Cox models that were stratified by sex and cohort and adjusted for age at risk. Results--Individual participant data from 26 prospective cohort studies (total number of participants 306 620) that reported incident cases of SAH (fatal and/or nonfatal) were available for analysis. During the median follow-up period of 8.2 years, a total of 236 incident cases of SAH were observed. Current smoking (HR, 2.4; 95% CI, 1.8 to 3.4) and SBP >140 mm Hg (HR, 2.0; 95% CI, 1.5 to 2.7) were significant and independent risk factors for SAH. Attributable risks of SAH associated with current smoking and elevated SBP ( Conclusions--Cigarette smoking and SBP are the most important risk factors for SAH in the Asia-Pacific region.
Revised on April 3, 2005
Accepted on April 26, 2005
Smoking and Elevated Blood Pressure Are the Most Important Risk Factors for Subarachnoid Hemorrhage in the Asia-Pacific Region. An Overview of 26 Cohorts Involving 306 620 Participants
Valery Feigin MD, PhD*;
140 mm Hg) were 29% and 19%, respectively. There were no significant associations between the risk of SAH and cholesterol, BMI, or drinking alcohol. The strength of the associations of the common cardiovascular risk factors with the risk of SAH did not differ much between Asian and Australasian regions.
Key words: meta-analysis • risk factors • subarachnoid hemorrhage
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