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Cigarette smoking and risk of intracranial aneurysms in middle-aged women
  1. Christopher S Ogilvy1,
  2. Santiago Gomez-Paz1,
  3. Kimberly P Kicielinski1,
  4. Mohamed M Salem1,
  5. Yosuke Akamatsu1,
  6. Muhammad Waqas2,3,
  7. Hamid Hussain Rai2,3,
  8. Joshua S Catapano4,
  9. Sandeep Muram5,
  10. Mohammed Elghareeb6,
  11. Adnan H Siddiqui3,7,
  12. Elad I Levy3,7,
  13. Michael T Lawton4,
  14. Alim P Mitha5,
  15. Brian L Hoh6,
  16. Adam Polifka6,
  17. W Christopher Fox6,
  18. Justin M Moore1,
  19. Ajith J Thomas1
  1. 1 Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States
  3. 3 Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, United States
  4. 4 Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
  5. 5 Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
  6. 6 Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
  7. 7 Department of Neurosurgery and Radiology, Canon Strole and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, United States
  1. Correspondence to Dr Christopher S Ogilvy, Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston 02215, Massachusetts, USA; cogilvy{at}


Background and purpose We previously reported a single-centre study demonstrating that smoking confers a six-fold increased risk for having an unruptured intracranial aneurysm (UIA) in women aged between 30 and 60 years and this risk was higher if the patient had chronic hypertension. There are no data with greater generalisability evaluating this association. We aimed to validate our previous findings in women from a multicentre study.

Methods A multicentre case-control study on women aged between 30 and 60 years, that had magnetic resonance angiography (MRA) during the period 2016–2018. Cases were those with an incidental UIA, and these were matched to controls based on age and ethnicity. A multivariable conditional logistic regression was conducted to evaluate smoking status and hypertension differences between cases and controls.

Results From 545 eligible patients, 113 aneurysm patients were matched to 113 controls. The most common reason for imaging was due to chronic headaches in 62.5% of cases and 44.3% of controls. A positive smoking history was encountered in 57.5% of cases and in 37.2% of controls. A multivariable analysis demonstrated a significant association between positive smoking history (OR 3.7, 95%CI 1.61 to 8.50), hypertension (OR 3.16, 95% CI 1.17 to 8.52) and both factors combined with a diagnosis of an incidental UIA (OR 6.9, 95% CI 2.49 to 19.24).

Conclusions Women aged between 30 and 60 years with a positive smoking history have a four-fold increased risk for having an UIA, and a seven-fold increased risk if they have underlying chronic hypertension. These findings indicate that women aged between 30 and 60 years with a positive smoking history might benefit from a screening recommendation.

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  • Twitter @SantiagoGP92, @_AdnanSiddiqui, @EladLevyMD, @mtlawton, @BrianHoh1, @wchrisfox, @DrAjithThomas

  • Contributors SG-P, KPK and CSO conceived and designed the study. SG-P, MMS, YA, MW, HHR, JSC, SM and ME collected the data. SG-P, MMS and YA analysed and interpreted the data under the supervision of JMM, AJT and CSO. SG-P and MMS did the statistical analyses. SG-P and CSO performed the literature search, drafted the paper and all authors reviewed and contributed important intellectual content and edited the manuscript.

  • Funding This work was supported by the Boston Marathon Chair of Research and Fight Like Frank Chair of Research grant from the Brain Aneurysm Foundation to SG-P (BAF2019-7894772232).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.