Smoking makes women vulnerable to brain bleeds

Smokers, especially female smokers, are at much greater risk for bleeding in the lining of the brain, known as subarachnoid hemorrhage, than non-smokers. This is the conclusion of a new study published in the journal Stroke.

Subarachnoid hemorrhage results from bleeding into the lining between the brain’s surface and underlying brain tissue. Although these are more common among women than they are among men, the reasons for this difference were unclear. While smoking is the main risk factor, this study examined the association between smoking habits and subarachnoid hemorrhage in a large prospective study.

While subarachnoid hemorrhage is rare, accounting for around 3 percent of all strokes, it can have serious consequences, causing paralysis, coma, and death.

A sudden, severe headache is the primary symptom of subarachnoid hemorrhage, and this most commonly occurs at the back of the head. Other symptoms include reduced consciousness and alertness, changes in mood and personality, and eye discomfort in response to bright light.

“Female sex has been described as an independent risk factor for subarachnoid hemorrhage, but we found strong evidence that the elevated risk in women is explained by vulnerability to smoking,” said lead study author Joni Valdemar Lindbohm, M.D., a physician in neurosurgery and public health at the University of Helsinki in Finland. “Our results suggest that age, sex and lifestyle risk factors play a critical role in predicting which patients are at risk for subarachnoid hemorrhage and emphasize the importance of effective smoking cessation strategies.”

Further, among light smokers, 1 to 10 cigarettes per day, women were 2.95 times more likely to have subarachnoid hemorrhage compared to non-smokers, while men who smoked comparable amounts of cigarettes were 1.93 times more likely. Women who smoked 11 to 20 cigarettes per day were 3.89 times more likely to have subarachnoid hemorrhage compared to non-smokers, while men who smoked comparable amounts of cigarettes were 2.13 times more likely.

Women who smoked 21 to 30 cigarettes per day were more than 8.35 times likely to have subarachnoid hemorrhage compared to non-smokers, while men who smoked comparable amounts of cigarettes were 2.76 times more likely. “Our results suggest that age, sex and lifestyle risk factors play a critical role in predicting which patients are at risk for subarachnoid hemorrhage and emphasize the importance of effective smoking cessation strategies,” Lindbohm explained.

But it is not all bad news; the researchers found that quitting smoking can significantly reduce the risk of subarachnoid hemorrhage.

The results of the analysis revealed that men and women who had not smoked for at least 6 months had a risk of subarachnoid hemorrhage that was comparable to non-smokers.

"There is no safe level of smoking," stresses Dr. Lindbohm. "Naturally the best option is never to start. Quitting smoking, however, can reduce the risk for subarachnoid hemorrhage in both sexes."

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