Having a higher biological age increases the risk of death in the event of a subarachnoid hemorrhage

Achieving a biological age lower than one's chronological age reduces the risk of death in the event of a cerebral aneurysm rupture, known as a subarachnoid hemorrhage. However, it does not prevent one of the most common complications of this pathology, vasospasm. This is the first time this relationship has been highlighted. The study, published in the Journal of Neurology, Neurosurgery & Psychiatry, was led by researchers from the Hospital del Mar, in collaboration with the Josep Carreras Leukemia Research Institute..

"Regardless of your chronological age, presenting a biologically older or younger age compared to your peers is an independent risk factor for developing these complications", explains Dr. Adrià Macias-Gómez, lead author of the study, attending physician in the Neurology Service at Hospital del Mar and researcher at its research institute. Specifically, the study considered two of the most common complications following subarachnoid hemorrhage, vasospasm and delayed cerebral ischemia, as well as mortality and poor prognosis after twelve months.

To do this, the biological age of 277 individuals treated at Hospital del Mar between 2007 and 2020 was analyzed. Their average age was 55 years, and two-thirds were women. 51% experienced vasospasm, and one in four, ischemia. 20.6% died within the year following the episode, and 19% suffered sequelae in the same period.

Having a younger body protects

The researchers analyzed biological age using blood samples from patients with various tools that allow quantification based on epigenetics, the part of genetic information that can be modified by lifestyle habits or external factors. In those who died, they saw how it was 1.1 years older than what would correspond to their chronological age. That is, they were more aged.

Regarding vasospasm, which is a narrowing of the brain's arteries that occurs days after subarachnoid hemorrhage and can lead to strokes, the opposite situation occurs. It occurred in rejuvenated individuals. Specifically, between 1 and 1.2 years less than what would correspond to them. A discovery that researchers attribute to having blood vessels in better condition and with more capacity to react to the irritation caused by the hemorrhage.

As for delayed cerebral ischemia, which is one of the most serious complications after subarachnoid hemorrhage, and whose origin is not fully understood, it has been seen how biological age may be influencing its development. In biologically younger people, it would do so through greater vasospasm. And in older people, through other pathways. This discovery could open new hypotheses about the pathophysiological pathways involved in the appearance of this complication associated with a high risk of suffering sequelae, to find a cure.

Analyzing possible treatment pathways

The results lead Dr. Macias-Gómez to point out that "epigenetics, unlike the genome, can vary according to environmental factors and your lifestyle habits. Therefore, leading a healthy life and avoiding this aging improves prognosis." A fact that opens the door to researching whether modifying biological age through innovative DNA editing therapies, among others, can improve the prognosis of patients suffering from subarachnoid hemorrhage.

"Our study suggests that the biological mechanisms involved in the aging process may have an influence on the development of diseases. This could explain why two people of the same chronological age have a different evolution in the face of the same ailment", explains Dr. Elisa Cuadrado, author of the work, attending physician in the Neurology Service at Hospital del Mar and researcher at the center's research institute.

Professionals from the Neurology, Neurosurgery, and Intensive Medicine services at Hospital del Mar participated in the study.

Image: From left to right Ángel Ois, Elisa Cuadrado, Adrià Macias-Gómez and Joan Jiménez Balado

Reference article: Macias-Gómez A, Jiménez-Balado J, Fernández-Pérez I, et al The influence of epigenetic biological age on key complications and outcomes in aneurysmal subarachnoid haemorrhage Journal of Neurology, Neurosurgery & Psychiatry Published Online First: 01 February 2024. doi: 10.1136/jnnp-2023-332889