Risk factors and their combined effects on the incidence rate of subarachnoid hemorrhage--a population-based cohort study

Abstract

Background: Prospective studies on the risk factors for subarachnoid hemorrhage (SAH) are limited. Moreover, the effect of risk factors on the incidence rates of SAH is not well known about.

Aims: In this study, we aimed to identify risk factors for SAH and characterize subgroups in a population with a high incidence of SAH.

Methods: After recording multiple potential risk factors for SAH at the time of enrollment, first ever SAH events between 1972 and 2009 were recorded through the nationwide Causes of Death Register and Hospital Discharge Register for the population-based cohort of 64 349 participants, who participated in the National FINRISK Study between 1972 and 2007 in Finland.

Results: During the follow-up time of 1.26 million person-years (median 17.9 years, range 0 to 37.9 years), 437 persons experienced fatal or non-fatal SAH. Crude SAH incidence was 34.8 (95% confidence interval: 31.7-38.2) per 100 000 person-years among ≥ 25-year-old persons. Female sex, high blood pressure values and current smoking were confirmed as risk factors for SAH. Previous myocardial infarction, history of premature stroke (any kind) in mother and elevated cholesterol levels in men were identified as new risk factors for SAH. Depending on the combination of risk factors, SAH incidence varied between 8 and 171 per 100 000 person-years.

Conclusions: New and previously reported risk factors appear to have a much stronger association with the incidence of SAH than is ordinarily seen in cardiovascular diseases. Risk factor assessments may facilitate the identification of high-risk persons who should be the focus of preventive interventions.

Figure 1. Crude SAH incidences in 25-year-old and older people on the basis of risk factor profiling.

Error bars represent 95% confidence intervals. sBP* = systolic blood pressure ≥159 mmHg. sBP† = systolic blood pressure ≤122 mmHg. smoking = current smoking. matstroke = history of premature stroke (any kind) in mother.