Hormonal Factors and Risk of Aneurysmal Subarachnoid Hemorrhage

Mhurchú, Cliona Ní; Anderson, Craig S.; Jamrozik, Konrad; Hankey, Graeme J.; Dunbabin, David

doi:10.1161/01.str.32.3.606

Cited by 111 publications

(64 citation statements)

References 41 publications

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“…Our results may be different from results of some of the previous case control studies. 19,22 The increased risk in postmenopausal women is similar to the increased risk observed with oral contraceptive use in premenopausal women. 11 There was a 40% higher risk of SAH among women who used oral contraceptives in previous analyses.…”

Section: Discussionmentioning

confidence: 78%

“…19 In the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS), 21% of women with SAH had used or were actively using HRT. 22 In an analysis of the Danish National Patient Register, 35% of Danish women 45-64 years of age with SAH had either used or were actively using HRT. 25 We found that the risk of SAH was 1.5-fold higher among postmenopausal women on HRT after adjusting for potential confounders.…”

Section: Discussionmentioning

confidence: 99%

“…30 The protective effect of estrogen seemed to occur through activation of estrogen receptor-b, a predominant subtype of estrogen receptor in human intracranial aneurysms and cerebral arteries. Hormone replacement therapy (HRT) was associated with reduced risk of spontaneous SAH in postmenopausal women in most 19,22 but not all case control studies. 25 The Women's Health Initiative (WHI) randomized trial 33 assessed the effect of estrogen plus progestin on ischemic and hemorrhagic stroke in 608 women 50-79 years of age with an average follow-up of 5.6 years.…”

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confidence: 99%

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Hormone replacement therapy and the risk of subarachnoid hemorrhage in postmenopausal women

Qureshi¹,

Malik²,

Saeed³

et al. 2016

JNS

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T he risk of intracranial aneurysm formation and subarachnoid hemorrhage (SAH) is higher in postmenopausal women compared with premenopausal women. 8,13,18,19,28 Reduced levels of estrogen in postmenopausal women may increase the risk of aneurysm formation and rupture by reduction in collagen and elastin content and reduced elasticity of arterial walls. 3 In an experimental intracranial aneurysm mouse model, estrogen prevented aneurysmal rupture in ovariectomized mice. 30The protective effect of estrogen seemed to occur through activation of estrogen receptor-b, a predominant subtype of estrogen receptor in human intracranial aneurysms and cerebral arteries. Hormone replacement therapy (HRT) was associated with reduced risk of spontaneous SAH in postmenopausal women in most 19,22 but not all case control studies. 25 The Women's Health Initiative (WHI) randomized trial 33 assessed the effect of estrogen plus progestin on ischemic and hemorrhagic stroke in 608 women 50-79 years of age with an average follow-up of 5.6 years. There was a nonsignificant protective effect on hemorrhagic stroke (HR 0.82, 95% CI 0.43-1.56). However, the study was underpowered because there were only 10 SAH events among the randomized patients. A meta-analysis 24 found a small nonsignificant protective effect of HRT on risk of SAH (HR 0.8, 95% CI 0.57-1.04).We performed this study to determine the effect of abbreviatioNs HRT = hormone replacement therapy; RR = relative risk; SAH = subarachnoid hemorrhage; SE = standard error; WHI = Women's Health Initiative. obJective The incidence of subarachnoid hemorrhage (SAH) increases after menopause. Anecdotal data suggest that hormone replacement therapy (HRT) may reduce the rate of SAH and aneurysm formation in women. The goal of this study was to determine the effect of HRT on occurrence of SAH in a large prospective cohort of postmenopausal women. methods The data were analyzed for 93,676 women 50-79 years of age who were enrolled in the observational arm of the Women's Health Initiative Study. The effect of HRT on risk of SAH was determined over a period of 12 ± 1 years (mean ± SD) using Cox proportional hazards analysis after adjusting for potential confounders. Additional analysis was performed to identify the risk associated with "estrogen only" and "estrogen and progesterone" HRT among women. results Of the 93,676 participants, 114 (0.1%) developed SAH during the follow-up period. The rate of SAH was higher among women on active HRT compared with those without HRT used (0.14% vs 0.11%, absolute difference 0.03%, p < 0.0001). In unadjusted analysis, participants who reported active use of HRT were 60% more likely to suffer an SAH (RR 1.6, 95% CI 1.1-2.3). Compared with women without HRT use, the risk of SAH continued to be higher among women reporting active use of HRT (RR 1.5, 95% CI 1.0-2.2) after adjusting for age, systolic blood pressure, cigarette smoking, alcohol consumption, body mass index, race/ethnicity, diabetes, and cardiovascular disease. The risk of SAH was nonsignificantly h...

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Hormone replacement therapy and the risk of subarachnoid hemorrhage in postmenopausal women

Qureshi¹,

Malik²,

Saeed³

et al. 2016

JNS

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“…60 Indeed, an earlier age at menopause is associated with the presence of a CA, and hormone replacement therapy protects against SAH. 66,67 Additionally, animal studies have shown a significant protective role of estrogen against the formation and progression of CAs. 68 The protective role of estrogen is likely related to its beneficial effects on the inflammatory reaction in cerebral vessels and the function of endothelial cells.…”

Section: Common Risk Factors For Casmentioning

confidence: 99%

Review of Cerebral Aneurysm Formation, Growth, and Rupture

Chalouhi

Hoh

Hasan

2013

Stroke

446

279

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“…Modifiable risk factors for aneurysm formation in the general population are active tobacco smoking, arterial hypertension, and heavy alcohol consumption. Estrogen intake might also be a risk factor [27] , and some authors suggest coffee consumption and use of cocaine [28] . Non-modifiable risk factors are: positive family history for IAs, ADPKD and some rarer inheritable conditions such as type IV Echlers-Danlos disease [29] , type 1 neurofibromatosis and Marfan's syndrome [30] .…”

Section: S C R E E N I N G F O R I N T R a C R A N I A L Aneurysmsmentioning

confidence: 99%

Intracranial Manifestations of Autosomal Dominant Polycystic Kidney Disease

Kulesza

Gradzik

Niemczyk

2016

International Journal of Neurology Research

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Autosomal dominant polycystic kidney disease (ADPKD) belongs to the most common genetic disorders, and affects approximately 1 in 1,000 people in the general population. ADPKD is a systemic disease, with multiple extrarenal manifestations, like arterial hypertension, aneurysms, and cysts in solid organs, including liver, pancreas, and spleen. Among intracranial manifestations of ADPKD, the most important are intracranial aneurysms. ADPKD is a well-known risk factor for them. Additionally, arachnoid cysts may be found in some ADPKD patients. Rarely, pineal cysts and choroid plexus cysts are observed in this population. The aim of our paper is to present intracranial manifestations that may be observed in ADPKD.

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Hormonal Factors and Risk of Aneurysmal Subarachnoid Hemorrhage

Cited by 111 publications

References 41 publications

Hormone replacement therapy and the risk of subarachnoid hemorrhage in postmenopausal women

Hormone replacement therapy and the risk of subarachnoid hemorrhage in postmenopausal women

Review of Cerebral Aneurysm Formation, Growth, and Rupture

Intracranial Manifestations of Autosomal Dominant Polycystic Kidney Disease

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