Sunday, May 18, 2003

Smokers at risk of stroke

By Laura Sauerbeck
Guest columnist

News about SARS is everywhere. Everyone knows what SARS is. But because May is Stroke Awareness Month, this is a good time to inform people of a frightening condition with a similar acronym: SAH.

SAH stands for subarachnoid hemorrhage - a bleeding stroke in the brain - and it is much more likely to kill an American today than SARS. An estimated 30,000 Americans will experience SAH this year, and 40 percent of them will die. Many more will be left with permanent disabilities.

Tragically, SAH typically strikes adults between the ages of 40 and 60, when they are in the prime of their lives. The No. 1 risk factor to SAH is smoking.

People who assume that their cigarette habit won't catch up with them until they've lived a full life probably have not considered the risk of SAH. Somebody who smokes cigarettes is 4.5 times more likely to have an SAH than somebody who does not. SAH is caused by a ruptured aneurysm, a balloon-like bulge in a blood vessel that is literally a time bomb in the brain. The vessel can become thin and weak because of smoking, high blood pressure, or excessive alcohol consumption.

If, after the aneurysm bursts, blood flows into a protective membrane around the brain known as the subarachnoid space, the rupture becomes a subarachnoid hemorrhage, or SAH. Treatment for SAH involves emergency neurosurgery.

SAH strikes suddenly and without warning. Survivors describe it as "the worst headache I ever had." Fifteen percent of those who suffer SAH never make it to the hospital, and 40 percent die within a month.

At the University of Cincinnati College of Medicine, researchers with the Greater Cincinnati/Northern Kentucky Stroke team are involved in two important studies of SAH. We know that family history plays a role in whether or not a smoker will experience a ruptured aneurysm, or SAH, and we are trying to discover why. In the meantime, any smoker with a family history of SAH is advised to quit smoking immediately, and teens whose family has experienced SAH should never begin smoking in the first place.

Screening is advisable for those at high risk, because aneurysms often can be clipped surgically or neutralized with coils before they rupture.

Recently, I completed a study about the behavior of smokers who had experienced a stroke. Of 365 patients, 44 percent were no longer smoking three months after their stroke. Those who were still smoking, meanwhile, had greatly reduced the number of cigarettes they were smoking.

Sometimes, having a stroke helps motivate behavioral change. But with SAH, people often don't live to make that change. Wouldn't it be wonderful if people stopped smoking before they had a stroke? Then SAH might become as rare as SARS.

Laura Sauerbeck is a R.N. and Clinical Research Coordinator for the Greater Cincinnati/Northern Kentucky Stroke Team.

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