title: An analysis of the effects of smoking and other cardiovascular risk factors on obliteration rates after arteriovenous malformation radiosurgery.
abstract: OBJECTIVE
  To assess the relationships of smoking and other cardiovascular disease risk factors (hypertension, diabetes, hypercholesterolemia, and gender) to rates of radiosurgery-induced obliteration of arteriovenous malformations (AVM).
  
  
  METHODS
  We evaluated follow-up imaging and clinical data in 329 AVM patients who received gamma knife radiosurgery at the University of Pittsburgh between 1987 and 1994. There were 113 smokers, 29 hypertensives, 5 diabetics, 4 hypercholesterolemics, 159 male patients, and 170 female patients. All patients had regular clinical or imaging follow-up for a minimum of 3 years after radiosurgery.
  
  
  RESULTS
  Multivariate analysis showed that smoking had no effect on AVM obliteration (p > 0.43). Hypertension, diabetes, and hypercholesterolemia had no discernible effect on AVM obliteration in this study (p > 0.78). However, females aged 12-49 had a statistically significant lower in-field obliteration rate than males (78% vs. 89%, p = 0.0102).
  
  
  CONCLUSIONS
  Smoking has no effect on AVM obliteration. Hypertension, diabetes, and hypercholesterolemia had no discernible effect in this study. Further study is needed to establish whether estrogen has a vascular protective effect that could partially limit radiosurgical AVM obliteration, as suggested by this study.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bhatnagar
authors.forename: J C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: D
authors.initials: D
authors.lastname: Kondziolka
authors.forename: A
authors.initials: A
authors.lastname: Niranjan
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications*; D006973:Hypertension / Q000150:complications*; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016634:Radiosurgery; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*