Modifiable cardiovascular risk factors in patients with sporadic cerebral cavernous malformations: obesity matters

Objective To assess the influence of modifiable cardiovascular risk
factors on hemorrhage risk of sporadic cerebral cavernous malformations
(CCMs). Methods From 1219 consecutive CCM patients (2003-2018), adult
subjects with sporadic CCM and complete MRI were included. We evaluated
presence of intracerebral hemorrhage (ICH) as mode of presentation,
occurrence of ICH during follow-up and risk factors arterial hypertension,
diabetes mellitus, hyperlipidemia, nicotine abuse, and obesity
(BMI>30kg/m²). Impact of risk factors on ICH at presentation was
calculated using univariate and multivariate logistic regression with age-
and sex-adjustment. We performed Kaplan Meier and Cox regression to
analyze cumulative 5-year-risk for (re-)bleeding.  Results We
included 682 CCM patients. The univariate logistic regression showed a
significant relationship (OR=1.938, 95% CI: (1.120–3.353), p=0.018)
between obesity and ICH as mode of presentation. Multivariate adjusted
logistic regression confirmed significant correlation with OR=1.902 (95%
CI: 1.024–3.532, p=0.042). Cox regression did not identify predictors for
occurrence of (re-)hemorrhage (p>0.05; Hazard ratios: arterial
hypertension 1.112 (95% CI: 0.622–1.990), diabetes 0.850 (95% CI:
0.208–3.482), hyperlipidemia 0.719 (95% CI: 0.261–1.981), nicotine abuse
1.123 (95% CI: 0.591–2.134), and obesity 0.928 (95% CI:
0.416–2.070)).  Conclusions This study provides evidence that
obesity may be a risk factor for CCM hemorrhage. It was significantly
associated with ICH as mode of presentation. Other risk factors (arterial
hypertension, diabetes mellitus, hyperlipidemia and current nicotine
abuse) showed no such effect. None of the factors showed to be independent
predictors for cumulative 5-year-risk of
(re-)bleeding.