title: Risk factors for all-cause death after diagnosis of unruptured intracranial aneurysms.
abstract: OBJECTIVE
  We investigated all-cause mortality and risk factors of death of patients with unruptured intracranial aneurysms (UIAs) in a long-term follow-up study.
  
  
  METHODS
  A total of 142 patients with 181 UIAs diagnosed between 1956 and 1978 when UIAs were not treated were included in this study. Patients were followed until death or until 2011 to 2012. Mortality rates and risk factors were studied with Kaplan-Meier survival analysis and the Cox proportional hazards regression models.
  
  
  RESULTS
  During 3,530 person-years, 113 (80%) had died, giving an average annual mortality of 3.2%. Of them, 19 (17%) died of aneurysm rupture from the index UIA, 6 (5%) of other aneurysm-related causes, and 2 (2%) of unspecified subarachnoid hemorrhage. The remaining 86 died of causes unrelated to intracranial aneurysms. The cumulative death rate was 20% (95% confidence interval 14%-27%) at 10 years and 60% (52%-68%) at 30 years. Independent risk factors for subsequent death were patient age (adjusted hazard ratio 1.09 per year, 95% confidence interval 1.05-1.12, p < 0.001), male sex (2.81, 1.59-4.96, p < 0.001), heavy alcohol use (4.22, 2.22-8.02, p < 0.001), and cigarette smoking (1.72, 0.97-3.07, p = 0.064). History of hypertension, family history of subarachnoid hemorrhage, and diameter of UIA predicted death only in univariable analysis.
  
  
  CONCLUSIONS
  In patients of working age with a UIA, alcohol consumption and cigarette smoking are modifiable risk factors for untimely death through several causes and should be taken into account when treatment is considered.
authors.affiliation: From the Department of Clinical Neurosciences (S.J.), University of Helsinki; and Department of Neurosurgery (H.L.), Helsinki University Central Hospital, Finland. seppo.juvela@helsinki.fi.
authors.forename: Seppo
authors.initials: S
authors.lastname: Juvela
authors.affiliation: From the Department of Clinical Neurosciences (S.J.), University of Helsinki; and Department of Neurosurgery (H.L.), Helsinki University Central Hospital, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality