Female smokers four times more likely to suffer brain aneurysm than nonsmokers

Female smokers between 30 and 60 years old are four times more likely to suffer a brain aneurysm compared to women who don’t smoke, according to new research published Tuesday. The findings may necessitate a second look at screening recommendations for this group.

Neurosurgery experts from the U.S. and Canada compared brain scans, smoking history and underlying health conditions of more than 500 women for their investigation. The group shared their conclusions in the Journal of Neurology, Neurosurgery & Psychiatry.

In addition to the higher risk for female smokers overall, those with underlying chronic hypertension and a history of smoking were seven times more likely to have an unruptured intracranial aneurysm.

“These findings indicate that women aged between 30 and 60 years with a positive smoking history could benefit from a screening recommendation,” first author Christopher S. Ogilvy, MD, with Beth Israel Deaconess Medical Center, and colleagues wrote in the study.

The conclusions build off the group’s previously reported single-center study that revealed a six-fold increased risk for an unruptured aneurysm in female smokers within the same age range.

Wanting to validate those past results, Ogilvy et al. enrolled 545 women from multiple centers who underwent a magnetic resonance angiography scan between 2016 and 2018.

In total, 113 aneurysm patients were matched to an equal number of controls. Imaging revealed 152 of the total cohort had 185 unruptured aneurysms; some contained more than one. Abnormalities were more frequent in women who smoked about 20 cigarettes per day compared to 12 for controls. Aneurysm patients also tended to smoke for 29 years, on average. 

Most received imaging due to chronic headaches (62.5% vs. 44.3% for control patients). And 57.5% had a positive smoking history compared to 37.2% in the control group.

Currently, screening is recommended only for patients with two or more first-degree family members with a history of intracranial aneurysms, and those with a specific form of kidney disease, but the authors say this may require a second look.

"Given these numbers, and the data presented in the current study, consideration should be given to screening for UIA in women aged between 30 and 60 years who smoke cigarettes,” the group concluded.