*Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. Connolly et al Management of Aneurysmal Subarachnoid Hemorrhage 1713 aneurysms rupture appears to be smaller in those patients with the combination of hypertension and smoking than in those with either risk factor alone.31 (3) Significant life events such as financial or legal problems within the past month may increase the risk of aSAH.32 (4) Aneurysm size 7 mm has been shown to be a risk factor for rupture.33 (5) There does not appear to be an increased risk of aSAH in pregnancy, delivery, and puerperium.34,35 Inflammation appears to play an important role in the pathogenesis and growth of intracranial aneurysms.36 Prom- inent mediators include the nuclear factor -light-chain en- hancer of activated B cells (NF- B),37 tumor necrosis factor, macrophages, and reactive oxygen species. Although there are no controlled studies in humans, 3-hydroxy-3- methylglutaryl coenzyme A reductase inhibitors (statin )38 and calcium channel blockers may retard aneurysm forma- tion through the inhibition of NF- B and other pathways. Among the risk factors for aSAH, clearly attributable and modifiable risks are very low body mass index, smoking, and high alcohol consumption.31,39,40 Yet, despite marked improvements in the treatment of hypertension and hyper- lipidemia and the decrease in rates of smoking over time, the incidence of aSAH has not changed appreciably in 30 It is possible that diet increases the risk of stroke in general and aSAH in particular. 