Risk Factors for Intracerebral Hemorrhage in a Pooled Prospective Study

Abstract

Background and Purpose-Few prospective studies have reported risk factors for intracerebral hemorrhage (ICH), and results are inconsistent. We studied risk factors for ICH in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). Methods-The ARIC cohort was recruited in 1987 to 1989 and involves 15 792 men and women, aged 45 to 64 years at baseline, sampled from 4 US communities. The CHS cohort was recruited in 1989 to 1993 and involves 5888 men and women, aged 65 or over at baseline, sampled from 4 US communities. Baseline measurements included many potential vascular risk factors. The cohorts were followed for incident stroke events. Results-Over 263 489 person-years of follow-up, 135 incident ICH events occurred. In a multivariable model, age, African-American ethnicity (versus Whites), and hypertension were positively associated with incident ICH, whereas low-density lipoprotein cholesterol and triglycerides were inversely related to incident ICH. Participants with systolic blood pressure Ն160 mm Hg or diastolic blood pressure Ն110 mm Hg had 5.55 (95% CI 3.07 to 10.0) times the rate of ICH as nonhypertensives. Sex, smoking, alcohol intake, body mass index, waist-to-hip ratio, waist circumference, and diabetes were not related to ICH. Conclusions-In this pooled cohort the risk factors for ICH were older age, African-American ethnicity, hypertension, lower LDL-C, and lower triglycerides.

Cardiovascular Disease Epidemiology in Asia

“…38, 39 Serum total, LDL or non-high-density lipoprotein (HDL) cholesterol levels or the LDL/HDL cholesterol ratio have been positively associated with risk of IHD, whereas HDL cholesterol levels were inversely associated with the risk. 26-28,40, 41 To predict 5-year probabilities of developing acute myocardial infarction, the non-HDL cholesterol model was found to have better predictive ability (area under the receiver-operating curve [AUC]=0.825) than the total cholesterol model (AUC=0.815).…”

Cerebrovascular Diseases

“…In other words, the cholesterol level is recognized to be a risk factor only for atherothrombotic cerebral infarction, and the major risk factor for all types of cerebral infarction, including atherothrombotic cerebral infarction, is hypertension 9) . Many reports in various countries, including Japan, have stated that hypocholesterolemia is a risk factor for cerebral hemorrhage 16,25) . A meta-analysis of cohort studies found that a decrease in the cholesterol level by 1 mmol/L (38.6 mg/dL) is associated with an increase in the frequency of cerebral hemorrhage of 19% 21) .…”

Treatment Targets in Intracerebral Hemorrhage

“…Despite the association of low cholesterol levels [122,123] and the use of a statin with ICH [124], there is a growing interest in the pleiotropic effects of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (i.e., statins). The promising neuroprotective benefit of the statins in acute ischemic stroke [125][126][127] has led to a similar evaluation in ICH models.…”