Background:
Unruptured intracranial aneurysms (IAs) have a prevalence of 3% in the adult population and can lead to aneurysmal subarachnoid haemorrhage (SAH), which still carries a poor prognosis with high morbidity and case-fatality. Preventive treatment comes with a risk for stroke up to 4% and for death up to 0.3%. Since the risk of rupture in most incidental diagnosed IAs is less than the risk of preventive repair, conservative treatment options, that accompany observation with follow-up imaging, are urgently needed.
Recent studies showed that a high intake of omega-3-fatty acids lead to a reduction of stroke incidence, especially in women. On a molecular level omega-3-fatty acids exert different ways of anti-inflammatory effects, i.e. reduction in pro-inflammatory macrophages, recruitment of anti-inflammatory macrophages. Vital substances as Vitamin K2 seem to inhibit the differentiation of vascular smooth muscle cells (vSMCs) leading to reduced atherosclerosis and reduce pro-inflammatory mediators.
In pathogenesis of IAs inflammatory processes as recruitment of macrophages followed by degradation of the extracellular matrix as well as differentiation of vSMCs within the vascular wall play a major role leading to IA formation and IA rupture.
Aim:
The study aims to show the protective role of omega-3-fatty acids and vital substances on the pathogenesis of IAs. We hypothesize that the intake of omega-3-fatty acids and vital substances is associated with a reduction of IA presence and IA rupture in terms of SAH in the UK Biobank cohort.
Methods, Project duration:
Based on the UK Biobank cohort diet differences in participants without IAs, patients with unruptured IAs and patients with ruptured IAs shall be analysed mainly by t-test, non-parametric tests, correlation, logistic regression and cox regression. Analyses and manuscript preparation would take approximately 18-24 months.
Public health impact:
In most patients with unruptured IAs the risk for stroke and death in case of preventive repair outweighs the risk for rupture in case of observation. Conservative treatment options that even lower the rupture risk are urgently needed. Apart from this major argument a further argument for IAs with a low rupture risk would be the financial costs: preventive repair costs approximately 12,000-20,000 EUR (10,150-17,000 GBP), imaging for observation strategy approximately 500 EUR (425 GBP). If the intake of omega-3-fatty acids was associated with a lower rupture risk, this would be a promising conservative treatment option for patients with IAs and could lead to even fewer costs by imaging postponement.