Modifiable vascular risk factors in patients with cerebral and spinal cavernous malformations: a complete 10-year follow-up study

Background and purpose: The aim was to investigate the effect of modifiable vascular risk factors on the risk of first and recurrent bleeding for patients with a cavernous malformation (CM) of the central nervous system (CNS) over a 10 -year period.Methods: A retrospective review of our CM institutional database was performed spanning from 2003 to 2021. The inclusion criteria were non-missing serial magnetic resonance imaging studies and clinical baseline metrics such as vascular risk factors. The exclusion criteria were patients who underwent surgical CM removal and patients with less than a decade of follow -up. Kaplan- Meier and Cox regression analyses were performed to determine the cumulative risk (10 years) of hemorrhage.Results: Eighty -nine patients with a CM of the CNS were included. Our results showed a non-significant increased risk of hemorrhage during 10 years of follow -up in patients using nicotine (hazard ratio 2.11, 95% confidence interval 0.86- 5.21) and in patients with diabetes (hazard ratio 3.25, 95% confidence interval 0.71- 14.81). For the presence of modifiable vascular risk factors at study baseline different cumulative 10 -year risks of bleeding were observed: arterial hypertension 42.9% (18.8%- 70.4%); diabetes 66.7% (12.5%- 98.2%); hyperlipidemia 30% (8.1%- 64.6%); active nicotine abuse 50% (24.1%- 76%); and obesity 22.2% (4%- 59.8%). Overall cumulative (10 -year) hemorrhage risk was 30.3% (21.3%- 41.1%). Conclusions: The probability of hemorrhage in untreated CNS CM patients increases progressively within a decade of follow -up. None of the modifiable vascular risk factors showed strong indication for an influence on hemorrhage risk, but our findings may suggest a more aggressive course in patients with active nicotine abuse or suffering from diabetes.