Eastern Finnish Saccular Intracranial Aneurysm Disease

107 Pages·2013·3.28 MB·English

by  Lindgren Antti

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Antti E Lindgren 6
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Eastern Finnish Saccular n
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Intracranial Aneurysm Disease E
Saccular intracranial aneurysms L
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(sIAs) are balloon-like vascular n
Role of Type 2 Diabetes and Hypertension d Antti E Lindgren
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bulges that develop at branching r
Temporal Pattern of Incidence e
points of intacranial arteries in ap- n Eastern Finnish Saccular
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proximately 3% of the population a
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during life. The rupture of sIA wall te Intracranial Aneurysm
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is the most frequent cause of aneu- F
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rysmal subarachnoid hemorrhage nis Disease
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(aSAH), a devastating form of stroke S
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that mainly affects the working-age cc
population. This study is a part of the ula Role of Type 2 Diabetes and Hypertension
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long-term research effort of Kuopio n
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sIA Database to characterize Eastern c
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Finnish sIA disease. In the present n
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study, we used an overall cohort of l A
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2904 consecutive sIA patients from eu
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1980 to 2007 to analyze temporal pat- ys
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terns of aSAH incidence and the role D
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of type 2 diabetes and hypertension e
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Publications of the University of Eastern Finland n
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Dissertations in Health Sciences ...
isbn 978-952-61-1203-9
ANTTI E LINDGREN

Eastern Finnish
Saccular Intracranial Aneurysm
Disease

Role of type 2 diabetes and hypertension
Temporal pattern of incidence

To be presented by permission of the Faculty of Health Sciences, University of
Eastern Finland for public examination at Kuopio University Hospital
Auditorium, Kuopio, on Friday, October 4th 2013, at 1 p.m.

Publications of the University of Eastern Finland
Dissertations in Health Sciences
Number 186

Department of Neurosurgery, Institute of Clinical Medicine,
School of Medicine, Faculty of Health Sciences, University of Eastern Finland
Kuopio
2013
Kopijyvä Oy
Kuopio, 2013

Series Editors:
Professor Veli-Matti Kosma, M.D., Ph.D.
Institute of Clinical Medicine, Pathology
Faculty of Health Sciences

Professor Hannele Turunen, Ph.D.
Department of Nursing Science
Faculty of Health Sciences

Professor Olli Gröhn, Ph.D.
A.I. Virtanen Institute for Molecular Sciences
Faculty of Health Sciences

Professor Kai Kaarniranta, M.D., Ph.D.
Institute of Clinical Medicine, Ophthalmology
Faculty of Health Sciences

Lecturer Veli-Pekka Ranta, Ph.D. (Pharmacy)
School of Pharmacy
Faculty of Health Sciences

Distributor:
University of Eastern Finland
Kuopio Campus Library
P.O.Box 1627
FI-70211 Kuopio, Finland
http://www.uef.fi/kirjasto

ISBN (print): 978-952-61-1203-9
ISBN (pdf): 978-952-61-1204-6
ISSN (print): 1798-5706
ISSN (pdf): 1798-5714
ISSN-L: 1798-5706
III

Author’s address: Department of Neurosurgery
Institute of Clinical Medicine
School of Medicine, Faculty of Health Sciences
University of Eastern Finland
KUOPIO
FINLAND

Supervisors: Professor Juha E Jääskeläinen, M.D., Ph.D.
Department of Neurosurgery
Institute of Clinical Medicine
School of Medicine, Faculty of Health Sciences
University of Eastern Finland
KUOPIO
FINLAND

Mikael von und zu Fraunberg, M.D., Ph.D.
Department of Neurosurgery
Institute of Clinical Medicine
School of Medicine, Faculty of Health Sciences
University of Eastern Finland
KUOPIO
FINLAND

Reviewers: Associate Professor Martin Lehecka, M.D., Ph.D.
Department of Neurosurgery
University of Helsinki
HELSINKI
FINLAND

Associate Professor Ville Vuorinen, M.D., Ph.D.
Department of Neurosurgery
University of Turku
TURKU
FINLAND

Opponent: Professor Tor Ingebrigtsen, M.D., Ph.D.
Department of Neurosurgery
University of North Norway
TROMSO
NORWAY
IVIV
V

Lindgren, Antti Elias
Eastern Finnish Saccular Intracranial Aneurysm Disease: Role of Type 2 Diabetes and
Hypertension, Temporal pattern of incidence.
University of Eastern Finland, Faculty of Health Sciences, 2013
Publications of the University of Eastern Finland. Dissertations in Health Sciences. 186. 2013. 85 p.
ISBN (print): 978-952-61-1203-9

ISBN (pdf): 978-952-61-1204-6
ISSN (print): 1798-5706

ISSN (pdf): 1798-5714
ISSN-L: 1798-5706

ABSTRACT
Saccular intracranial aneurysms (sIAs) form during life at the branching sites of
intracranial arteries. Rupture of sIA (sIA-SAH) is the most frequent cause of
aneurysmal subarachnoid hemorrhage. The Kuopio sIA Database
(www.uef.fi/ns) contains all cases of unruptured sIA(s) and sIA-SAH admitted
to Kuopio University Hospital (KUH) since 1980 in Eastern Finland. The
purchases of prescribed medicines by sIA patients (1994-2008) were obtained
from the national registry. (I) In a cohort of 1862 sIA-SAH patients (1980-2007),
Sunday and Monday were the most frequent and Saturday the least frequent
weekday on which SAH occurred. We could not identify any etiology to this
temporal pattern, and age or gender did not correlate with the Sunday and
Monday peaks. (II) In a cohort of 1058 sIA-SAH and 484 unruptured sIA
patients (1995-2007), 9% used antidiabetes medication. The incidence of type 2
diabetes did not significantly differ between the groups, suggesting that type 2
diabetes does not increase the risk of sIA-SAH. (III) In a cohort of 1053 sIA-SAH
and 467 unruptured sIA patients (1995-2007), 90% of the unruptured sIA
patients presented with hypertension, smoking, or familial sIA.
Antihypertensive medication was more frequent in the unruptured group (73%
vs. 62%), with higher age-adjusted incidence. Untreated hypertension was more
frequent in the sIA-SAH group at sIA diagnosis (29% vs. 23%). Size of
unruptured sIAs increased with age at sIA diagnosis, independently of
hypertension. Our results suggest that drug-treated hypertension is associated
with the formation of sIA pouches rather than their rupture. Our study stresses
the importance of blood pressure control in carriers of unruptured sIAs.

National Library of Medical Classification: Intracranial Aneurysm [C10.228.140.300.510.600]
Medical Subject Headings: Intracranial Aneurysm; Subarachnoid Hemorrhage; Type 2 Diabetes
Mellitus, Hypertension, Incidence
VIVI
VII

Lindgren, Antti
Itäsuomalainen Sakkulaarinen Aivovaltimoaneurysmatauti: Tyypin 2 diabeteksen ja
verenpaineen rooli, ilmaantuvuuden vaihtelu.
Itä-Suomen yliopisto, Terveystieteiden tiedekunta, 2013
Publications of the University of Eastern Finland. Dissertations in Health Sciences. 186. 2013. 85 s.
ISBN (print): 978-952-61-1203-9

ISBN (pdf): 978-952-61-1204-6
ISSN (print): 1798-5706

ISSN (pdf): 1798-5714
ISSN-L: 1798-5706

TIIVISTELMÄ
Sakkulaarinen intrakraniaalinen aneurysma (sIA) muodostuu kallonsisäisten,
aivojen pinnalla olevien valtimoiden haarautumiskohtiin noin 3%:lla väestöstä.
Aneurysmaattinen subaraknoidaalivuoto (aSAV), joka johtuu lähes aina sIA:n
puhkeamisesta (sIA-SAV), on aivoverenkiertohäiriön muoto, joka kohdistuu
pääasiassa työikäiseen väestöön. Kuopion Aneurysmarekisteri (www.uef.fi/ns)
sisältää kaikki aSAV- ja sIA-potilaat, jotka ovat tulleet hoitoon Kuopion
yliopistolliseen sairaalaan (KYS) vuodesta 1980 lähtien. Reseptilääkkeiden
ostotiedot on yhdistetty aneurysmarekisteriin kansallisesta tietokannasta. (I)
Vuosina 1980–2007 1862 sIA-SAV–potilaan kohortissa sunnuntai ja maanantai
olivat yleisimmät ja lauantai oli harvinaisin vuotopäivä. Syy esiintyvyyden
vaihtelulle ei selvinnyt ja ikä ja sukupuoli eivät vaikuttaneet
esiintyvyyshuippuihin. (II) 1058 sIA-SAV potilaasta ja 484 vuotamattomasta
sIA-potilaasta (1995–2007) 9 % oli käyttänyt diabeteslääkkeitä. Ryhmien välillä
ei ollut merkittävää eroa diabeteksen ikävakioidussa ilmaantuvuudessa, mikä
viittaa siihen, että tyypin 2 diabeteksella ei ole vaikutusta sIA-SAV:n
esiintyvyyteen. (III) 1053 aSAV-potilaan ja 467 vuotamattoman sIA-potilaan
kohortissa (1995–2007) verenpainelääkityksen käyttö oli yleisempää (73 % vs. 62
%), ja verenpaineen ikävakioitu ilmaantuvuus oli suurempi vuotamattomilla.
Ainoastaan 10% vuotamattomista potilaista ei käyttänyt verenpainelääkitystä,
tupakoinut tai kuulunut aneurysmasukuun. sIA-SAV-potilailla oli enemmän
hoitamatonta verenpainetautia ennen aneurysmadiagnoosia (29 % vs. 23 %).
Vuotamattoman sIA:n koko lisääntyi iän myötä, verenpaineesta riippumatta.
Löydöksemme osoittaa että lääkehoidettu verenpaine liittyy ensisijaisesti sIA:n
muodostumiseen. Hoitamaton verenpainetauti voi altistaa aSAV:lle.
.
Tuloksemme korostavat verenpaineen hoidon tärkeyttä anerysmapotilailla

Luokitus: C10.228.140.300.510.600
Yleinen Suomalainen asiasanasto: aneurysma, esiintyvyys, aivot, aivotutkimus, valtimot,
aivoverenvuoto, verenpaine, diabetes, aivovaltimoaneurysma
VIIIVIII
IX

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