Patient-related, modifiable risk factors—in addition to arterial hypertension, established in PHASES—are current cigarette smoking and heavy alcohol consumption. 14, 15 For cigarette smoking, a dose-dependent detrimental effect has been recently reported: a case-control study including 4701 patients with 6411 UIAs highlighted that smoking intensity and duration are associated with the incidence of SAH. 24 However, the detrimental effect of alcohol, including a specific dose threshold for such an effect, has not been replicated in several studies. Further, it remains unclear within which time the risk of aneurysm rupture decreases in patients with UIA after normalization of blood pressure, cessation of smoking, or heavy alcohol consumption. It has been suggested that stimulants, for example, cocaine, are risk factors for rupture, but it also remains incompletely understood whether these risk factors are truly independent because stimulants result in episodes of increased blood pressure or are often concomitantly consumed in smokers. 25