Endovascular Fellow University of Buffalo Neurosurgery Buffalo, New York, United States
Introduction: Aneurysmal subarachnoid hemorrhage is more prevalent in post-menopausal women and it has been postulated that this relationship is hormonally driven by lower circulating levels of estrogens. We examined the association between circulating plasma estrogen levels and subsequent development of aneurysmal subarachnoid hemorrhage in women using a prospective, nested case-control approach.
Methods: Women from the Nurses’ Health Study with confirmed aneurysmal subarachnoid hemorrhage (n=38) were matched with controls (n=38) on age, smoking, menopausal status, and hormone therapy. Plasma estriol, estradiol and sex hormone-binding globulin (SHBG) were measured at baseline, prior to the development of aSAH, and were assessed using liquid chromatography tandem mass spectrometry. Conditional logistic regressions were performed to assess the association between hormone levels and incident aSAH, and their associations with risk factors including smoking and hypertension.
Results: A total of 38 cases with aneurysmal subarachnoid hemorrhage and 38 case-matched controls were included, with mean estriol and estradiol levels at 162+/-155 pg/mL and 44+/-67pg/mL, vs 158+/-247pg/mL and 47+/-60pg/mL, respectively. Plasma estriol, estradiol, and SHBG were not associated with the subsequent development of aneurysmal subarachnoid hemorrhage in our conditional logistic regression. Women with a history of current or former smoking were associated with lower levels of circulating estriol (Beta -0.35+/-0.12, p=0.004), and estradiol (Beta-0.63+/-0.16, p=0.0002) levels, but this association was not observed with hypertension.
Conclusion : In this study, we did not find an association between estrogen levels and incidence of aneurysmal subarachnoid hemorrhage in women. There was an association between former and current smokers with lower levels of estrone and estradiol. Further studies are needed to understand this relationship between estrogens and cigarette smoking in aneurysmal subarachnoid hemorrhage in women.
