Intracerebral hemorrhage is the second most common subtype of stroke. In recent decades our understanding of intracerebral hemorrhage has improved. New risk factors have been identified; more knowledge has been obtained on previously known risk factors; and new imaging techniques allow for in vivo assessment of preclinical markers of intracerebral hemorrhage. In this review the latest developments in research on intracerebral hemorrhage are highlighted from an epidemiologic point of view. Special focus is on frequency, etiologic factors and pre-clinical markers of intracerebral hemorrhage.

Stroke incidence rates have decreased in developed countries over the past 40 years, but trends vary across populations. We investigated whether age-and-sex-specific stroke incidence rates and associated risk factors as well as preventive medication use have changed in Rotterdam in the Netherlands during the last two decades. The study was part of the Rotterdam Study, a large population-based cohort study among elderly people. Participants were 10,994 men and women aged 55–94 years who were stroke-free at baseline. Trends were calculated by comparing the 1990 subcohort (n = 7516; baseline 1990–1993) with the 2000 subcohort (n = 2883; baseline 2000–2001). Poisson regression was used to calculate incidence rates and incidence rate ratios in age-and-sex-specific strata. We further compared the prevalence of stroke risk factors and preventive medication use in the two subcohorts. In the 1990 subcohort 467 strokes occurred during 45,428 person years; in the 2000 subcohort 115 strokes occurred in 18,356 person years. Comparing the subcohorts, incidence rates decreased by 34% in men, but remained unchanged in women. Blood pressure levels increased between 1990 and 2000, whereas the proportion of current cigarette smokers decreased in men, but not in women. There was a strong increase in medication use for treatment of stroke risk factors across all age categories in both sexes. Our findings suggest that in Rotterdam between 1990 and 2008 stroke incidence rates have decreased in men but not in women.

Background and Purpose-Many studies have investigated the role of plasma von Willebrand factor level in coronary heart disease, but few have investigated its role in stroke. The aim of this study was to determine if von Willebrand factor levels are associated with the risk of stroke. Methods-The study was part of the Rotterdam Study, a large population-based cohort study among subjects aged Ն55 years. We included 6 250 participants who were free from stroke at baseline (1997 to 2001) and for whom blood samples were available. Follow-up for incident stroke was complete up to January 1, 2005. Data were analyzed with Cox proportional hazards models adjusted for age and sex and additionally with models adjusted for other potential confounders including ABO blood group. A subgroup analysis was performed in participants without atrial fibrillation.Effect modification by sex was tested on a multiplicative and on an additive scale. Results-During an average follow-up time of 5.0 years, 290 first-ever strokes occurred, of which 197 were classified as ischemic. The risk of stroke increased with increasing von Willebrand factor levels (age-and sex-adjusted hazard ratios per SD increase in von Willebrand factor level:

Objective-Low serum total cholesterol levels are associated with an increased risk of symptomatic intracerebral hemorrhage and with presence of asymptomatic cerebral microbleeds. The relative contribution of lipid fractions to these associations is unclear and requires investigation. We determined whether serum HDL-cholesterol, LDL-cholesterol, and triglycerides are associated with risk of intracerebral hemorrhage and presence of cerebral microbleeds. Methods and Results-Nine thousand sixty-eight stroke-free community-dwelling persons aged Ն55 were followed from baseline (1990 -2001) Key Words: epidemiology Ⅲ lipids Ⅲ cerebral microbleeds Ⅲ intracerebral hemorrhage Ⅲ triglycerides I ntracerebral hemorrhage accounts for about 10% to 15% of strokes and is a devastating disease for which there are currently no curative treatment options. 1,2 Therefore, identification of modifiable risk factors is highly important. Low levels of serum total cholesterol have long been recognized as a possible risk factor for intracerebral hemorrhage. 3 The exact role of cholesterol in the pathogenesis of intracerebral hemorrhage is unclear, although some studies suggest that low cholesterol levels make the cerebrovascular endothelium fragile and vulnerable for leakage and rupture. 4 -6 Low total cholesterol levels also relate to the presence of cerebral microbleeds, 7,8 which are thought to be asymptomatic precursors of symptomatic intracerebral hemorrhage. 9,10 Establishing overlap in risk factors for intracerebral hemorrhage and cerebral microbleeds may thus aid in the early detection of persons at an increased risk of intracerebral hemorrhage.Although various cohort studies show that serum total cholesterol levels are inversely related with intracerebral hemorrhage, [11][12][13][14][15][16][17][18][19][20][21][22] it is unclear how various serum lipid fractions associate with intracerebral hemorrhage. Studies investigating lipid fractions, ie, LDL-cholesterol, HDL-cholesterol, and triglycerides, have reported inconsistent results. [13][14][15][16][17]19,[23][24][25] However, recent evidence suggests that the association between total cholesterol levels and risk of intracerebral hemorrhage is mainly driven by low triglyceride levels. 19,23 Still, further confirmation of these results is needed. Moreover, it is unclear whether similar patterns of lipid fractions also underlie the association of cholesterol with cerebral microbleeds.Therefore, we investigated in a large population-based cohort of community-dwelling elderly people whether serum total cholesterol and in particular the levels of LDL-cholesterol, HDL-cholesterol, and triglycerides are associated with the risk of intracerebral hemorrhage. Because we also aimed to investigate the potential of these lipid fractions as risk factors for preclinical disease, we studied the associations between lipid fractions and the presence of cerebral microbleeds. Methods Source PopulationThe Rotterdam Study is an ongoing prospective population-based cohort study that focuses on causes a...

Abstract-Increased circulating amino-terminal pro-B-type natriuretic (NT-proBNP) levels are a marker of cardiac dysfunction but also associate with coronary heart disease and stroke. We aimed to investigate whether increased circulating NT-proBNP levels have additive prognostic value for first cardiovascular and cerebrovascular events beyond classic risk factors. In a community-based cohort of 5063 participants free of cardiovascular disease, aged Ն55 years, circulating NT-proBNP levels and cardiovascular risk factors were measured. Participants were followed for the occurrence of first major fatal or nonfatal cardiovascular event. A total of 420 participants developed a first cardiovascular event (108 fatal). After adjustment for classic risk factors, the hazard ratio for cardiovascular events was 2.32 (95% CI: 1.55 to 2.70) in men and 3.08 (95% CI: 1.91 to 3.74) in women for participants with NT-proBNP in the upper compared with the lowest tertile. Corresponding hazard ratios for coronary heart disease, heart failure, and ischemic stroke were 2.01 (95% CI: 1.14 to 2.59), 2.90 (95% CI: 1.33 to 4.34), and 2.06 (95% CI: 0.91 to 3.18) for men and 2.95 (95% CI: 1.30 to 4.55), 5.93 (95% CI: 2.04 to 11.2), and 2.07 (95% CI: 1.00 to 2.97) for women. Incorporation of NT-proBNP in the classic risk model significantly improved the C-statistic both in men and women and resulted in a net reclassification improvement of 9.2% (95% CI: 3.5% to 14.9%; Pϭ0.001) in men and 13.3% (95% CI: 5.9% to 20.8%; PϽ0.001) in women. We conclude that, in an asymptomatic older population, NT-proBNP improves risk prediction not only of heart failure but also of cardiovascular disease in general beyond classic risk factors, resulting in a substantial reclassification of participants to a lower or higher risk category. (Hypertension. 2010;55:785-791.)