Smokers and hypertensive individuals have higher risk of sudden death from brain bleed

November 14, 2019

Subarachnoid haemorrhage is a severe stroke subtype that is caused by a rupture of a brain aneurysm, an enlargement in brain vessel wall.

Up to one in four subarachnoid haemorrhage patients die quickly after the bleed at home, on the road to a hospital, or in an emergency room. These patients never reach hospital wards and are often incorrectly diagnosed. In many countries, these sudden deaths are classified as sudden cardiac deaths since routine autopsies are rarely conducted outside Nordic countries.

If only patients who survive the initial bleed and reach hospital wards are included in studies on risk factors of subarachnoid haemorrhage, such studies are very likely biased, because they are unable to study risk factors relating to the most devastating outcome, namely sudden death.

Two recent hospital-based studies, that excluded patients who died before reaching hospital wards, reported that smokers and hypertensive individuals have better chances to survive from subarachnoid haemorrhage than non-smokers and those with normal blood pressures.

These findings puzzled researchers and clinicians, because they contradicted earlier reports. For decades, the researchers and clinicians have known that smoking and high blood pressure are the two most important risk factors for subarachnoid haemorrhage, but now the studies suggest that the same factors would paradoxically protect from subarachnoid haemorrhage-related death.

A Finnish study, published in the distinguished Neurology journal, shows that when researches are able to include those people who die before reaching hospital wards, the paradoxical protective effect of smoking and high blood pressure is reversed. Specifically, the study showed that smokers and hypertensive individuals die more frequently before they reach hospital wards than non-smokers and those with normal blood pressure. When these heavy smokers and hypertensive people are left out from statistical analyses, the results are misleading.

"Due to the mandatory autopsies for all sudden deaths in Finland, we were able to identify and include data on those individuals who died before reaching hospital wards. This in turn allowed us to show how results change when all people with subarachnoid haemorrhage, not only those surviving to hospitals, are included in the analyses." says physician Joni Lindbohm, the principal author of the research article.

"In practise, our results show that risk factor and survival estimates of subarachnoid haemorrhage from studies that exclude people dying quickly after the bleed are unreliable. This is important to recognize because most subarachnoid haemorrhage studies are still hospital-based and do not include data on sudden deaths," neurosurgeon, Dr. Miikka Korja states.

According to Lindbohm and Korja, the best way to minimize the risk to sudden death from subarachnoid haemorrhage is to quit smoking and lower elevated blood pressure values.
The researchers followed 65,521 population-based FINRISK participants during 1.52 million person-years and identified 445 first-ever hospitalized aSAHs and 98 sudden-death aSAHs occurring between 1974 and 2014 (FINRISK / Finnish institute for health and welfare)

University of Helsinki

Related Smoking Articles from Brightsurf:

Smoking rates falling in adults, but stroke survivors' smoking rates remain steady
While the rate of Americans who smoke tobacco has fallen steadily over the last two decades, the rate of stroke survivors who smoke has not changed significantly.

What is your risk from smoking? Your network knows!
A new study from researchers at Penn's Annenberg School for Communication found that most people, smokers and non-smokers alike, were nowhere near accurate in their answers to questions about smoking's health effects.

Want to quit smoking? Partner up
Kicking the habit works best in pairs. That's the main message of a study presented today at EuroPrevent 2019, a scientific congress of the European Society of Cardiology (ESC).

Smoking and mortality in Asia
In this analysis of data from 20 studies conducted in China, Japan, South Korea, Singapore, Taiwan and India with more than 1 million participants, deaths associated with smoking continued to increase among men in Asia grouped by the years in which they were born.

Predictors of successfully quitting smoking among smokers registered at the quit smoking clinic at a public hospital in northeastern Malaysia
In the current issue of Family Medicine and Community Health, Nur Izzati Mohammad et al. consider how cigarette smoking is one of the risk factors leading to noncommunicable diseases such as cardiovascular and respiratory system diseases and cancer.

Restaurant and bar smoking bans do reduce smoking, especially among the highly educated
Smoking risk drops significantly in college graduates when they live near areas that have completely banned smoking in bars and restaurants, according to a new study in the American Journal of Epidemiology.

How the UK smoking ban increased wellbeing
Married women with children reported the largest increase in well-being following the smoking bans in the UK in 2006 and 2007 but there was no comparable increase for married men with children.

Smoking study personalizes treatment
A simple blood test is allowing Vanderbilt University Medical Center (VUMC) researchers to determine which patients should be prescribed varenicline (Chantix) to stop smoking and which patients could do just as well, and avoid side effects, by using a nicotine patch.

A biophysical smoking gun
While much about Alzheimer's disease remains a mystery, scientists do know that part of the disease's progression involves a normal protein called tau, aggregating to form ropelike inclusions within brain cells that eventually strangle the neurons.

A case where smoking helped
A mutation in the hemoglobin of a young woman in Germany was found to cause her mild anemia.

Read More: Smoking News and Smoking Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to