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PubMed1999

Living non-related versus related renal transplantation--its relationship to the social status, age and gender of recipients and donors.

BACKGROUND: Persistent differences between social classes and genders exist in the quality of medical care due to disparities in need and access. METHODS: 149 haemodialysis (HD) patients including 114 renal transplant candidates, and their proposed live donors were interviewed and followed for 4 years. Differences in need and access were analysed among the living non-related compared to related renal transplant according to social status, age and gender of recipients and donors. Also the motive for organ-donation as well as the recipient's survival was compared between living non-related and related renal transplantation. RESULTS: The proportion of females among renal transplant candidates was significantly lower than among HD-patients. Females were significantly less likely to be recipients, but more likely to be donors of renal allografts, particularly if they were unemployed. Initially all of the living non-related donors claimed to have altruistic motives for organ-donation but gift rewarding, drug abuse, unemployment, and economical deadlock, urgent need of money were significantly frequent than among living related donors. The donation process lasted significantly longer in females and in living non-related donors and there was a trend for higher mortality in recipient of living non-related grafts. Almost all of the living non-related donors disappeared after organ-donation without subsequent follow-up. CONCLUSIONS: Females are transplanted less frequently, but donate kidneys more frequently than males in living non-related transplantation programmes. There is an excess of vulnerable people among living non-related donors.

Adolescent↗
PubMed2006

Depression and cigarette smoking independently relate to reduced health-related quality of life among Canadians living with hepatitis C.

BACKGROUND: Many people living with chronic viral hepatitis C (HCV) report reduced health-related quality of life. The relative contribution of behavioural, psychosocial and HCV disease factors to reduction in HCV health-related quality of life is not well understood. The objectives of the present study were to compare standardized health-related quality of life scores between Canadian HCV patients and age-matched Canadian and American norms, and to examine the relative contribution of biopsychosocial variables (ie, cigarette smoking, alcohol intake and depression) to health-related quality of life scores among Canadian HCV patients. METHODS: HCV RNA-positive patients were recruited during their first visit to the Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario). A questionnaire assessing health behaviours, health-related quality of life and depressed mood was completed. Data on liver studies, liver biopsy findings and HIV serostatus were also collected. RESULTS: A total of 123 participants (71% men) ranging from 20 to 67 years of age were evaluated. All had compensated liver function. Patients reported significantly lower health-related quality of life compared with age-matched Canadian and American normative samples. In a series of hierarchical multiple regression models, depression and smoking were independently related to compromised health-related quality of life scores, even after controlling for sociodemographic variables and health behaviours. DISCUSSION: These results highlight the value of adopting a biopsychosocial model of HCV care. Depressed mood and smoking behaviour should be evaluated in HCV patients. Empirically validated psychological and pharmacological treatments for depression and smoking cessation may improve health-related quality of life in HCV infected patients.

Adult↗
PubMed2005

Success of a smoking cessation program among smoking relatives of patients with serious smoking-related pulmonary disorders.

The aim of the study was to investigate the success of a smoking cessation program among the smoking relatives of patients with serious smoking-related disorders and to determine whether having a relative with such a disorder influences the rate of success of the program. The relatives of patients with chronic obstructive pulmonary disease (COPD) and lung cancer who wanted to quit smoking were included in the smoking cessation program (group I, n = 34). During the same period, the same number of subjects with relatives free of any smoking-related diseases were included as a control group (group II, n = 34). Intensive behavioral therapy and motivational support was given to all subjects. Nicotine replacement therapy was administered to 10 subjects (29.4%) in group I and 14 subjects (41.2%) in group II. The subjects were evaluated in the 1st, 2nd, 4th, 8th and 12th week and subsequently every 3 months for a year in the outpatient clinic and proactive telephone interviews were performed periodically. In group I, 23.5% of subjects had a relative with COPD, 61.8% had relatives with lung cancer, and 14.7% had relatives with both COPD and lung cancer. The rate of quitting smoking was 79.4 and 73.5% on the 15th day and 41.2 and 38.2% at the end of the 1st year in groups I and II, respectively (p > 0.05). We observed that having a relative with serious smoking-related disorders did not motivate smokers to quit smoking.

Age of Onset↗
PubMed1987

Prospective pricing system by diagnosis-related groups: comparison of federal diagnosis-related groups with high-risk obstetric care groups.

Of 468 diagnosis-related groups identified by the federal government for Medicaid reimbursement, 15 are related to obstetric hospital care. Each diagnosis-related group is considered a distinct group in which cases are homogeneous with respect to resource consumption. Because the diagnosis-related group system is based primarily on data from community and secondary care hospitals, it does not differentiate sufficiently among high-risk obstetric patients seen at tertiary care institutions, such as Florida's Regional Perinatal Intensive Care Centers. We developed an alternative scheme for diagnosis-related groups, called obstetric care groups, using the federal diagnosis-related groups as the model from which to depart. Data collected for 4192 women during a 2 1/2-year period indicate that obstetric care groups provide more homogeneous groups than diagnosis-related groups for our population of high-risk patients. The obstetric care groups differentiate between no complications, one complication, and two or more complications, while the diagnosis-related groups differentiate only between no complications and one or more complications. Also, complications for obstetric care groups are based on only 19 diagnoses that contribute significantly to resource consumption, while the list of possible complications exceeds 200 for diagnosis-related groups. Although the obstetric care group classification system is simpler than that for diagnosis-related groups, it results in a more accurate reimbursement of hospitalization charges for high-risk obstetric care.

Diagnosis-Related Groups↗
PubMed2003

'Relatives are a resource, but...': registered nurses' views and experiences of relatives of residents in nursing homes.

Registered Nurses (RNs) working in nursing homes in Sweden have obligations towards the residents' relatives, besides the care of residents. Relatives' involvement and satisfaction with the care partly depend on their contacts and communication with the staff. This study aimed to explore and describe RNs' views and experiences of relatives of residents who live in nursing homes. Open interviews were conducted with 19 RNs at three nursing homes. The verbatim-transcribed interviews were subjected to qualitative content analysis. Relatives were seen as a resource (with some restrictions) and nice, although demanding. The RNs saw relatives as part of their work--a part that could be time-consuming and had low priority. Interviewees noticed a difference between young and old relatives, and between female and male relatives. A large proportion of accounts could be related to issues about communication and interpersonal relationships with relatives. Building a trusting relationship with relatives may result in them being involved in residents' care and thus giving the nurses time rather than consuming time.

Attitude of Health Personnel↗
PubMed2001

High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems.

BACKGROUND AND AIMS: Static and dynamic functions of the wall of large arteries are largely unknown in cirrhosis in vivo. The present study was undertaken to determine arterial compliance (COMP(art)) in relation to vasodilator and vasoconstrictor systems in patients with cirrhosis. In addition, vasoactivity was manipulated by inhalation of oxygen. STUDY POPULATION AND METHODS: In 20 patients with alcoholic cirrhosis and 12 controls we determined COMP(art) (stroke volume relative to pulse pressure), cardiac output, plasma volume, systemic vascular resistance, central circulation time, plasma catecholamines, renin activity, endothelin-1, and calcitonin gene related peptide (CGRP) at baseline and during oxygen inhalation. RESULTS: COMP(art) was significantly increased in cirrhotic patients compared with controls (1.32 v 1.06 ml/mm Hg; p< 0.05) and inversely related to plasma adrenaline levels (r=-0.53; p<0.02) but positively related to circulating levels of CGRP (r=0.58; p<0.01). No significant relation was found for plasma noradrenaline, renin activity, or endothelin-1. COMP(art) was positively related to plasma volume (r=0.50; p<0.02) and inversely to systemic vascular resistance (r=-0.69; p<0.001) and central circulation time (r=-0.49; p<0.02). During oxygen inhalation, COMP(art) decreased (-13%; p<0.005) and systemic vascular resistance increased (+10%; p<0.001) towards normal values without significant changes in mean arterial pressure. Plasma adrenaline (-16%; p<0.01) decreased and the relation to COMP(art) disappeared. The relation of COMP(art) to CGRP and circulatory variables remained unchanged. CONCLUSION: Elevated arterial compliance in cirrhosis is related to low adrenaline, high CGRP, and systemic hyperdynamics but not to indicators of the activated vasoconstrictor systems (noradrenaline, renin, endothelin-1). Thus the altered static and dynamic characteristics of the wall of large arteries are intimately associated with circulatory and vasodilatory derangement in cirrhosis but biomanipulation indicates that the changes are, at least in part, reversible during isobaric conditions.

Adult↗
PubMed1992

Elevated fibrin-related and fibrinogen-related antigens in patients with liver disease.

Patients with liver disease have a variety of coagulation abnormalities. These derangements are of uncertain origin and do not always correlate with disease severity or activity. We have measured the levels and proportions of the total fibrin-related and fibrinogen-related antigens, the principal fibrin (D-dimer) and fibrinogen (D-monomer) degradation fragments and intermediates of fibrin formation (fibrin monomers) in patients with a variety of acute and chronic liver diseases in whom all known other precipitating causes of disseminated intravascular coagulation had been excluded. Fibrin-related and fibrinogen-related antigens were extracted from serum using antihuman fibrinogen-IgG covalently bound to activated amino-phenylthioether paper disks and were subjected to 4% to 11% sodium dodecyl sulfate-polyacrylamide gel electrophoresis under nonreducing conditions. Fibrin-related and fibrinogen-related antigen proportions were determined by densitometry, and their levels were measured by radioimmunoassay. Levels of total fibrin-related and fibrinogen-related antigens (and D-dimer) were significantly elevated (p less than 0.01) in patients with cirrhosis (121 to 641 ng/ml) and hepatocellular carcinoma (416 to 8,786 ng/ml) when compared with patients with acute viral hepatitis (84 to 322 ng/ml) and control subjects (38 to 186 ng/ml). In addition, D-monomer levels were elevated. These findings strongly suggest that disseminated intravascular coagulation is a component of the coagulopathy of certain liver diseases. Because fibrin-related and fibrinogen-related antigens have anticoagulant, vasoactive and immunosuppressive properties, their elevated presence may be biologically significant in these patients.

Adult↗
PubMed1990

Long-term prosthesis-related and sudden cardiac-related complications after valve replacement for aortic stenosis.

Predictability of prosthesis-related and sudden cardiac-related complications was examined in 630 patients who were alive 30 days after valve replacement (1965 to 1986) for aortic stenosis. Follow-up totaled 4,072 patient-years. A variety of prosthetic valves, mainly mechanical, were used. The Cox regression model was used to identify independent risk factors and to estimate predicted event-freedoms relative to combinations of these risk factors. There were no risk factors for endocarditis (0.5 +/- 0.1 [number of events per 100 patient-years +/- the standard error]). Except for "other" prosthesis-related complications (0.4 +/- 0.1), adversely influenced by porcine bioprostheses (n = 15) and by the Lillehei-Kaster prosthesis (n = 25), only factors underlying diseased preoperative patient/cardiac status had predictive influence. Predicted 10-year event-freedoms for low-risk versus high-risk estimate were 86% versus 73% for thromboembolism (1.7 +/- 0.2), 95% versus 32% for anticoagulant-related hemorrhage (2.4 +/- 0.2), 69% versus 36% for all prosthesis-related complications (5.0 +/- 0.4), 93% versus 0% for sudden cardiac-related events (myocardial infarction and arrhythmia) (1.8 +/- 0.2), and 66% versus 0.5% for combined prosthesis-related and sudden cardiac-related morbidity and mortality (6.8 +/- 0.4). In 193 patients with coronary arteriography, coronary artery disease was a significant risk factor for each of the complication modalities examined except other prosthesis-related complications, prosthesis replacement, and endocarditis. Deciding to operate early in the course of aortic stenosis might "actively" reduce the rate of these complications.

Adult↗
PubMed2006

Age-related changes in cognitive conflict processing: an event-related potential study.

Cognitive tasks involving conflicting stimuli and responses are associated with an early age-related decline in performance. Conflict and conflict-induced interference can be stimulus- or response-related. In classical stimulus-response compatibility tasks, such as the Stroop task, the event-related potential (ERP) usually reveals a greater negativity on incongruent versus congruent trials which has often been linked with conflict processing. However, it is unclear whether this negativity is related to stimulus- or response-related conflict, thus rendering the meaning of age-related changes inconclusive. In the present study, a modified Stroop task was used to focus on stimulus-related interference processes while excluding response-related interference. Since we intended to study work-relevant effects ERPs and performance were determined in young (about 30 years old) and middle-aged (about 50 years old) healthy subjects (total n=80). In the ERP, a broad negativity developed after incongruent versus congruent stimuli between 350 and 650 ms. An age-related increase of the latency and amplitude of this negativity was observed. These results indicate age-related alterations in the processing of conflicting stimuli already in middle age.

Adult↗
PubMed2004

Accelerated age-related decline of visual information processing in first-degree relatives of persons with schizophrenia.

A recent cross-sectional study suggested that persons with schizophrenia experience an accelerated age-related decline in performance on the Span of Apprehension task, a visual information processing paradigm. However, this study was not able to determine if such decline was primarily related to genetic loading for schizophrenia, as the decline may have been related to chronic neuroleptic use or other confounds found when studying persons with schizophrenia directly. To help address this question, the current study examined healthy first-degree relatives of persons with schizophrenia over a wide age range to investigate whether such age effects may be related to genetic loading for schizophrenia. Twenty-eight healthy first-degree relatives of persons with schizophrenia (ages 21-72) and 31 healthy controls (ages 19-75) were evaluated using the Span of Apprehension task with cross-sectional methodology. Results replicated and extended the earlier report examining persons with schizophrenia, as the data indicated a statistically significant accelerated age-related decline in performance in the relatives. While the study is limited by cross-sectional methodology, it suggests a genetically driven, age-related decline in visual information processing related to schizophrenia and informs future longitudinal studies that can more definitively address such a possibility.

Adult↗
PubMed1999

Relations among psychological trauma, dissociative phenomena, and trauma-related distress: a review and integration.

Recently, there has been a resurgence of interest in relations among psychological trauma, dissociative phenomena, and various forms of trauma-related distress that has spawned a prolific amount of research. To date, a relatively comprehensive review of this recent research is lacking. Thus, this paper provides such a review to help summarize and synthesize recent findings, illuminate study limitations, and offer suggestions for future research. In general, findings have revealed fairly strong and consistent relations among the constructs of trauma, dissociation, and trauma-related distress (e.g., posttraumatic stress disorder, borderline personality disorder, bulimia); individuals who have experienced a traumatic event are more likely to dissociate than individuals who have not, and individuals who experience more dissociative phenomena are more likely to also experience higher levels of trauma-related distress. It is theorized here that dissociative phenomena and subsequent trauma-related distress may relate to fears about death and fears about loss or lack of control above and beyond the occurrence of the traumatic event itself. Such fears about death and loss/lack of control may also help differentiate traumatized individuals who psychologically suffer to varying degrees. Possible functions of dissociation in response to trauma and in relation to forms of trauma-related distress are considered and discussed.

Acute Disease↗
PubMed1998

Relation of smoking to the incidence of age-related maculopathy. The Beaver Dam Eye Study.

To date, a number of reports have been published on the relation of cigarette smoking to age-related maculopathy, an important cause of blindness in the United States. However, few studies have examined the relation between smoking and the incidence of age-related maculopathy. In this report, the authors examine this association in persons aged 43-86 years (n = 3,583) at baseline who were participants in the baseline examination and 5-year follow-up of the Beaver Dam Eye Study, Beaver Dam, Wisconsin (1988-1990 and 1993-1995). Exposure data on cigarette smoking were obtained from questions about present and past smoking, duration of smoking, and the number of cigarettes smoked per day. Age-related maculopathy status was determined by grading stereoscopic color fundus photographs using the Wisconsin Age-related Maculopathy Grading System. After controlling for age, sex, vitamin supplement use, and beer consumption, men who smoked greater amounts of cigarettes were more likely to develop early age-related maculopathy (odds ratio (OR) per 10 pack-years smoked = 1.06, 95% confidence interval (CI) 1.00-1.13, p = 0.06) than men who had smoked less. This association was not observed in women. Men (OR = 3.21, 95% CI 1.09-9.45) and women (OR = 2.20, 95% CI 1.04-4.66) who were current smokers at the time of the baseline examination had significantly higher odds of developing large drusen (> or = 250 microns in diameter) after 5 years than those who had never smoked or who quit before the baseline study. Current or past history of cigarette smoking was not related to the incidence of retinal pigment epithelial depigmentation. The authors conclude that smoking appears to be related to the incidence of some lesions associated with early age-related maculopathy.

Adult↗
PubMed2006

Relationships among the level of response to alcohol and the number of alcoholic relatives in predicting alcohol-related outcomes.

BACKGROUND: The low level of response (LR) to alcohol is related to a family history (FH) of alcohol use disorders (AUDs), and each predicts alcohol-related outcomes. Few studies have evaluated the interrelationships between the number of alcoholic relatives, LR, and a range of alcohol-related outcomes. This study tests the hypotheses that there will be an inverse relationship between LR and FH and that LR will be a better predictor of the maximum quantity of alcohol consumed. METHODS: Data were extracted from personal interviews with 376 males from 20 years of follow-up in the San Diego Prospective Study. Level of response had been established at about age 20 through alcohol challenges in this population, about half of whom had at least one alcoholic relative. Face-to-face follow-ups with both the subjects and additional informants were carried out 10, 15, and 20 years later. These analyses used correlations and regressions to evaluate the relationship between the 2 major predictors (FH and LR) and 5 alcohol-related outcomes over 20 years of follow-up. RESULTS: As predicted, the alcohol challenge-based LR correlated significantly with the number of alcoholic relatives (up to -0.17 for subjects with clearly high and low LR scores). Each of the 2 predictors correlated with the 5 outcomes, including the maximum quantity of alcohol consumed since original testing, maximum frequency, nondiagnostic alcohol-related problems, the number of 11 DSM-IV (Fourth Diagnostic and Statistical Manual of Mental Disorders) abuse and dependence items, and having developed alcohol abuse or dependence. In hierarchical regression analyses, LR contributed significantly to the prediction of all 5 outcomes, even when considered in the context of FH, with only LR predicting drinking quantity and frequency, but both items adding to the prediction of alcohol-related problems and diagnoses. These results were not affected by the intensity of usual drinking when LR had been measured at age 20. CONCLUSIONS: Both FH and LR contributed to a range of alcohol-related outcomes, with LR alone significantly predicting maximum quantity and frequency in regression analyses.

Adult↗
PubMed1983

Influence of atrial systole on the Frank-Starling relation and the end-diastolic pressure-diameter relation of the left ventricle.

The influence of atrial systole on the left ventricular function curve (stroke volume vs end-diastolic pressure or end-diastolic diameter) and on the left ventricular end-diastolic pressure diameter relation was studied in nine anesthetized, open-chest dogs whose atrioventricular (AV) node had been completely blocked. Measurements were made during volume loading with the pericardium closed and opened and during alternate AV sequential pacing (to permit atrial contribution to ventricular filling) and AV simultaneous pacing (to prevent atrial contribution). When the pericardium was closed, withdrawal of the atrial contribution shifted the stroke-volume end-diastolic pressure relation downward, but did not shift the stroke volume-end-diastolic diameter relation, i.e., it reduced stroke volume for a given end-diastolic pressure according to a reduction in end-diastolic volume. The downward shift of the stroke volume-end-diastolic pressure relation was caused by an upward shift of the end-diastolic pressure-diameter relation, which, for a given end-diastolic pressure, resulted in a smaller end-diastolic diameter and, thus, in a smaller stroke volume. The reason for the upward shift in the end-diastolic pressure-diameter relation was that the atrium remained full and thus increased pericardial pressure by increasing pericardial volume. Opening the pericardium shifted the end-diastolic pressure-diameter relation downward and to the right, shifted the stroke volume-end-diastolic diameter relation upward and abolished the effect of withdrawal of the atrial contribution on these curves. We conclude that in the presence of an intact pericardium, atrial systole shifts the stroke volume-end-diastolic pressure relation because it shifts the end-diastolic pressure-diameter relation and it improves left ventricular performance by increasing preload.

Animals↗
PubMed2004

Relations of serum aldosterone to cardiac structure: gender-related differences in the Framingham Heart Study.

Aldosterone is associated with myocardial fibrosis in experimental studies and with left ventricular remodeling in heart failure patients. We hypothesized that aldosterone influences ventricular remodeling in people without congestive heart failure in the community. We examined the relations between serum aldosterone and echocardiographic left ventricular measurements in 2820 Framingham Study subjects (mean age 57 years, 58% women, 88% white) free of myocardial infarction and overt heart failure. Serum aldosterone levels were higher in women compared with men. In linear regression models (adjusted for age, systolic blood pressure, weight, height, diabetes, heart rate, hypertension treatment, and ethnicity), left ventricular wall thickness and relative wall thickness were positively related, and left ventricular diastolic dimensions were inversely related to serum aldosterone in women (P<0.05 for all), but not in men (P>0.20 for all). There was no effect modification of the relations observed in women by menopausal status. The gender-related differences in relations of serum aldosterone to relative wall thickness were consistent across subgroups defined on the basis of sex-specific median values of systolic blood pressure and body mass index. Fractional shortening, left ventricular mass, and left atrial dimensions were not related to serum aldosterone in either sex. In conclusion, in our community-based sample of individuals free of myocardial infarction and heart failure, serum aldosterone was positively associated with a left ventricular geometric pattern suggestive of concentric remodeling (increased left ventricular wall thickness and relative wall thickness but decreased internal dimensions) in women but not in men. Additional investigations are warranted to confirm these findings.

Aged↗
PubMed2005

Repetition-priming modulates category-related effects on event-related potentials: further evidence for multiple cortical semantic systems.

In the present study, the significance of category-related brain activations as an index of semantic memory structure was assessed within a repetition-priming paradigm during a lexical decision task. The interpretation of category-related effects has been debated since previous studies observed category-related brain activity mainly in tasks requiring explicit semantic categorization. Furthermore, categories were frequently associated with behavioral performance differences, which could have influenced the pattern of brain activation. Event-related potentials (ERPs) to words denoting objects from artifactual (e.g., tools) and natural categories (e.g., animals) were recorded while subjects were presented with words and pseudowords as distracters, which were repeatedly presented. Category-related ERP differences emerged in the time window of the N400, an electrophysiological index of semantic processing, over occipito-parietal and fronto-central regions as well as in the following window of a late positive potential. Repetition priming modulated these category-related ERP effects whereas behavioral repetition priming (faster reactions to repeated words) was comparable for both categories. Differences in ERP repetition effects were specifically due to diminished category-related activity at repeated presentation. The present results show that category-related brain activation is not confined to tasks requiring explicit semantic categorization. Most importantly, the study demonstrates that category-related brain activation can be specifically modulated by repetition priming in the absence of corresponding behavioral performance differences. These findings therefore substantiate the significance of category-related brain activations as reflections of semantic memory structure and support the notion of multiple cortical semantic systems.

Adult↗
PubMed2006

Tear film, contact lens, and patient-related factors associated with contact lens-related dry eye.

PURPOSE: To examine tear film, contact lens, medical, and patient-related factors associated with self-reported contact lens-related dry eye. METHODS: Four hundred fifteen contact lens wearers were recruited and enrolled in this phase of a larger cross-sectional study. A variety of tear film (e.g., interferometry, osmolality, phenol red thread, meibography, fluorescein, and lissamine green staining), contact lens (i.e., water content, refractive index, material), and patient-related (e.g., gender, sociodemographic, education, income, and medical health) factors were examined in relation to dry eye status. Univariate and multivariate logistic regression models were used to examine the relation between these tear film, contact lens, and patient-related factors associated with dry eye status. RESULTS: Of the 415 enrolled, the data from 360 were used in the analyses. The average age was 31.1 +/- 11.5 years, 245 (68%) participants were female, and 55.3% were classified as having-contact lens-related dry eye via self-report. Overall, 327 (90.8%) were hydrogel lens wearers and 33 (9.2%) were gas-permeable lens wearers. Several factors were shown to be related to dry eye status in multivariate modeling, including female gender (P = 0.007), lenses with higher nominal water content (P = 0.002), rapid prelens tear film thinning time (P = 0.008), frequent usage of over-the-counter pain medication (P = 0.02), limbal injection (P = 0.03), and increased tear film osmolality (P = 0.05). CONCLUSIONS: Contact lens-related dry eye may be explained mechanistically by increased tear film thinning times (evaporation or dewetting) resulting in increased tear film osmolality. Other contributing factors include the use of high-water-content lenses, which have traditionally been reported to be associated with less patient comfort than lower-water-content lenses, potentially due to spoilation and deposition. As found in other studies of dry eye, women are more likely to report contact lens-related dry eye than are men.

Adult↗
PubMed1999

Aneurysms in relatives of patients with subarachnoid hemorrhage: frequency and risk factors. MARS Study Group. Magnetic Resonance Angiography in Relatives of patients with Subarachnoid hemorrhage.

OBJECTIVE: To evaluate the frequency and identify risk factors of unruptured aneurysms in first-degree relatives of patients with sporadic subarachnoid hemorrhage (SAH). BACKGROUND: First-degree relatives (parents, siblings, and children) of patients with SAH have a three to seven times increased risk of SAH. METHODS: Magnetic resonance angiography (MRA) was performed in 626 first-degree relatives of a consecutive series of 193 index patients with "sporadic" SAH (participation rate, 78% of eligible relatives). The authors recorded demographic and medical data, and performed blood pressure measurements and blood tests (cholesterol, high-density lipid cholesterol, triglycerides, apoprotein A1, lipoprotein a, glucose). RESULTS: Aneurysms were found in 25 of 626 relatives (4.0%; 95% CI, 2.6 to 5.8%), and 6 relatives had multiple aneurysms. Index patients with multiple aneurysms and a younger age had a higher risk of aneurysms in relatives. Siblings of index patients had a four times higher risk than children. In screened relatives female sex, increasing age, polycystic kidney disease, hypertension, and elevated levels of cholesterol and glucose tended to be associated with a higher risk of aneurysms. No increase in risk was conferred by smoking or alcohol use, or by a previous family history of SAH or of atherosclerosis. CONCLUSIONS: First-degree relatives of index patients with sporadic subarachnoid hemorrhage have a 4.0% chance of intracranial aneurysms. Being a sibling of the index patient is the most important risk factor. Risk factors for general atherosclerosis (hypertension, smoking, hypercholesterolemia, high levels of blood triglycerides, lipoprotein a, and apoprotein A1) and use of alcohol do not increase the risk of intracranial aneurysms significantly in these relatives.

Adult↗