{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T17:26:47Z","timestamp":1743874007640},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Protease\/antiprotease imbalance is implicated in the pathogenesis of emphysema and may also lead to vessel wall weakening, aneurysm development, and rupture. However, it is unclear whether emphysema is associated with cerebral and aortic aneurysm rupture.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>\n              We performed a retrospective cohort study using outpatient and inpatient claims data from 2008 to 2014 from a nationally representative sample of Medicare beneficiaries \u226566 years of age. Our predictor variable was emphysema, and our outcome was hospitalization for either aneurysmal subarachnoid hemorrhage or a ruptured aortic aneurysm. All predictors and outcomes were defined using previously reported\n              <jats:italic>International Classification of Diseases, Ninth Revision, Clinical Modification<\/jats:italic>\n              diagnosis code algorithms. Survival statistics and Cox regression were used to compare risk between patients with and without emphysema.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>We identified 1\u2009670\u2009915 patients, of whom 133\u2009972 had a diagnosis of emphysema. During a mean follow-up period of 4.3 (\u00b11.9) years, we identified 4835 cases of aneurysm rupture, 433 of which occurred in patients with emphysema. The annual incidence of aneurysm rupture was 6.5 (95% CI, 6.4\u20136.8) per 10\u2009000 in patients without emphysema and 14.6 (95% CI, 13.3\u201316.0) per 10\u2009000 in patients with emphysema. After adjustment for demographics and known risk factors for aneurysmal disease, emphysema was independently associated with aneurysm rupture (hazard ratio, 1.7; 95% CI, 1.5\u20131.9). Emphysema was associated with both aneurysmal subarachnoid hemorrhage (hazard ratio, 1.5; 95% CI, 1.3\u20131.7) and ruptured aortic aneurysm (hazard ratio, 2.3; 95% CI, 1.9\u20132.8).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Patients with emphysema face an increased risk of developing subarachnoid hemorrhage and aortic aneurysm rupture, potentially consistent with shared pathways in pathogenesis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.024660","type":"journal-article","created":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T09:00:30Z","timestamp":1552986030000},"page":"992-994","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Emphysema"],"prefix":"10.1161","volume":"50","author":[{"given":"Ali","family":"Mahta","sequence":"first","affiliation":[{"name":"From the Department of Neurology (A.M., M.E.R., S.Y., K.L.F.), Warren Alpert Medical School of Brown University, Providence, RI"},{"name":"Department of Neurosurgery (A.M., M.E.R.), Warren Alpert Medical School of Brown University, Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander E.","family":"Merkler","sequence":"additional","affiliation":[{"name":"Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (A.E.M., J.E.B., H.K.), Weill Cornell Medicine, New York, NY."},{"name":"Department of Neurology (A.E.M., J.E.B., H.K.), Weill Cornell Medicine, New York, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E.","family":"Reznik","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (A.M., M.E.R., S.Y., K.L.F.), Warren Alpert Medical School of Brown University, Providence, RI"},{"name":"Department of Neurosurgery (A.M., M.E.R.), Warren Alpert Medical School of Brown University, Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaclyn E.","family":"Burch","sequence":"additional","affiliation":[{"name":"Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (A.E.M., J.E.B., H.K.), Weill Cornell Medicine, New York, NY."},{"name":"Department of Neurology (A.E.M., J.E.B., H.K.), Weill Cornell Medicine, New York, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shadi","family":"Yaghi","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (A.M., M.E.R., S.Y., K.L.F.), Warren Alpert Medical School of Brown University, Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank W.","family":"Sellke","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital (F.W.S.), Warren Alpert Medical School of Brown University, Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen L.","family":"Furie","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (A.M., M.E.R., S.Y., K.L.F.), Warren Alpert Medical School of Brown University, Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hooman","family":"Kamel","sequence":"additional","affiliation":[{"name":"Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (A.E.M., J.E.B., H.K.), Weill Cornell Medicine, New York, NY."},{"name":"Department of Neurology (A.E.M., J.E.B., H.K.), Weill Cornell Medicine, New York, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.01.040"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.02.291"},{"key":"e_1_3_3_4_2","first-page":"361","article-title":"Pathogenesis of COPD. Part I. The role of protease-antiprotease imbalance in emphysema.","volume":"12","author":"Abboud RT","year":"2008","unstructured":"Abboud, RT, Vimalanathan, S. Pathogenesis of COPD. Part I. The role of protease-antiprotease imbalance in emphysema. Int J Tuberc Lung Dis. 2008;12:361\u2013367.","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_3_3_5_2","first-page":"207","article-title":"[Balance of proteinases and antiproteinases and smoking tobacco].","volume":"79","author":"Ko\u0142odziejczyk J","year":"2011","unstructured":"Ko\u0142odziejczyk, J, Wojciechowska, M, Bartuzi, Z, Dziedziczko, A. [Balance of proteinases and antiproteinases and smoking tobacco]. Pneumonol Alergol Pol. 2011;79:207\u2013214.","journal-title":"Pneumonol Alergol Pol"},{"key":"e_1_3_3_6_2","doi-asserted-by":"crossref","first-page":"176582","DOI":"10.1155\/2015\/176582","article-title":"Activity of \u03b11-antitrypsin and some lysosomal enzymes in the blood serum of patients with chronic obstructive pulmonary disease after smoking cessation.","volume":"2015","author":"Wo\u017aniak B","year":"2015","unstructured":"Wo\u017aniak, B, Wo\u017aniak, A, Konca, J, G\u00f3recki, D, Mila-Kierzenkowska, C, Szpinda, M, et al. Activity of \u03b11-antitrypsin and some lysosomal enzymes in the blood serum of patients with chronic obstructive pulmonary disease after smoking cessation. Biomed Res Int. 2015;2015:176582.","journal-title":"Biomed Res Int"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-0487"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000032240.28636.bd"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.021594"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2015.01.008"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)92693-X"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1996.85.3.0503"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1996.84.5.0781"},{"key":"e_1_3_3_14_2","first-page":"34","article-title":"Absence of plasma protease-antiprotease imbalance in the formation of saccular cerebral aneurysms.","volume":"45","author":"Sakai N","year":"1999","unstructured":"Sakai, N, Nakayama, K, Tanabe, Y, Izumiya, Y, Nishizawa, S, Uemuara, K. Absence of plasma protease-antiprotease imbalance in the formation of saccular cerebral aneurysms. Neurosurgery. 1999;45:34\u201338; discussion 38.","journal-title":"Neurosurgery"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-015-0113-7"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.118.024660","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:32:15Z","timestamp":1715614335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.118.024660"}},"subtitle":["A Potential Risk Factor for Subarachnoid Hemorrhage and Ruptured Aortic Aneurysm"],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1161\/STROKEAHA.118.024660"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.118.024660","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]},"assertion":[{"value":"2018-11-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}