title: Excess mortality and cardiovascular events in patients surviving subarachnoid hemorrhage: a nationwide study in Sweden.
abstract: OBJECTIVE
  Survivors of aneurysmal subarachnoid hemorrhage (SAH) may have an increased risk of cardiovascular events because of shared risk factors. We compared incidences of vascular diseases, vascular death, and all-cause death after SAH with those in the general population.
  
  
  METHODS
  From the Swedish Hospital Discharge and Cause of Death registries, we identified patients with SAH between January 1987 and January 2003. Conditional on survival of 3 months after SAH, we calculated standardized mortality and incidence ratios with corresponding 95% CIs for vascular death, all-cause death, and fatal or nonfatal vascular diseases. Cumulative risks were estimated with survival analysis.
  
  
  RESULTS
  Of 17,705 patients with SAH (mean age, 59.7 years; 59.5% women), 11,374 survived at least 3 months after SAH. During follow-up (mean, 6.8 years), 2152 (18.9%) died. The risk of death was 12.9% within 5 years, 23.6% within 10 years, and 35.4% within 15 years after SAH. The overall standardized mortality ratio was 1.57 (95% CI, 1.44 to 1.70) for vascular death and 1.61 (95% CI, 1.52 to 1.70) for all-cause death. The standardized mortality ratios were particularly high in younger individuals, ranging from 2.1 to 3.7 for vascular death and from 2.1 to 2.6 for all-cause death for patients between 50 and 65 years of age. The standardized incidence ratio for fatal or nonfatal vascular diseases was 1.51 (95% CI, 1.45 to 1.56).
  
  
  CONCLUSIONS
  Mortality and risk of vascular diseases are increased in survivors of SAH. Prevention of new vascular diseases after SAH by management of risk factors seems important.
authors.affiliation: Department of Neurology, C03.236, University Medical Center Utrecht, PO Box 85500, 3584 CX Utrecht, The Netherlands. d.nieuwkamp@umcutrecht.nl
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Nieuwkamp
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Paul
authors.initials: P
authors.lastname: Blomqvist
authors.forename: Johanna
authors.initials: J
authors.lastname: Adami
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Hendrik
authors.initials: H
authors.lastname: Koffijberg
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000401:mortality*; D015897:Comorbidity / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult