Risk Factors for Intracerebral Hemorrhage

Abstract

Background and Purpose Risk factors for intracerebral hemorrhage (ICH) have been largely identified in case-control studies, with few longitudinal studies available. Methods Predictors of incident ICH among 27,760 African American (AA) and white participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study were assessed. Results There were 62 incident ICH events during an average follow-up of 5.7 years. The increase in risk with age differed substantially between AAs and whites (p = 0.006), with a 2.25-fold (95% CI: 1.63 – 3.12) increase per decade in whites, but no age association with ICH risk in AAs (HR = 1.09; 95% CI: 0.70 – 1.68). We observed increased risk among men, those with higher systolic blood pressure (SBP), and warfarin users. Conclusions The racial differences in the impact of age contributed to a risk of ICH that was over 5 times higher for AA than whites at age 45, but only about one-third as great by age 85. Confirming findings from other studies, men, participants with elevated SBP and warfarin users were also at greater risk. The contributors to the racial differences in ICH risk require additional investigation.

Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

“…Impaired CSF flow and resultant hydrocephalus is one of the most important mechanisms by which IVH may contribute to morbidity and mortality in ICH. Blacks with ICH/IVH presented at a younger age in our study and in others 3, 6, 7. Similarly, hydrocephalus after ICH with IVH occurs more commonly in younger patients 24.…”

“…ICH incidence rates are especially high among black patients compared to whites 3, 4, 5. In addition, blacks with ICH present at an earlier age than their white counterparts 6, 7…”

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

“…We observed an interaction between female sex and HIV status on the hazard of ICH, with a protective effect of female sex on ICH in HIV-uninfected individuals, but an estimate of no protective effect among those with HIV ( Several risk factors for ICH are more prevalent in HIV-infected individuals than in the general population, including hypertension, [13][14][15][16] a strong independent predictor of ICH. [17][18][19][20][21] Moreover, at younger ages, African Americans, who have been disproportionately affected by the HIV epidemic, 22 have a greater risk of ICH compared with whites. 17,20 The fact that ICH is associated with worse functional outcomes and higher case fatality rates than ischemic stroke 23,24 could lead to considerable loss of quality-adjusted life-years, particularly for Table 1 Clinical younger HIV-infected individuals.…”

“…[17][18][19][20][21] Moreover, at younger ages, African Americans, who have been disproportionately affected by the HIV epidemic, 22 have a greater risk of ICH compared with whites. 17,20 The fact that ICH is associated with worse functional outcomes and higher case fatality rates than ischemic stroke 23,24 could lead to considerable loss of quality-adjusted life-years, particularly for Table 1 Clinical younger HIV-infected individuals. Few studies have specifically evaluated ICH risk in HIV-infected compared with uninfected individuals.…”

Efectos de la edad sobre la morbimortalidad de la hemorragia intracerebral

“…Factores de riesgo asociados a hemorragia intracerebral: la baja incidencia de eventos por HIC, sobre todo en individuos jóvenes, torna desafiante la identificación de todos los factores de riesgo implicados en 8 su génesis . Al igual que en sujetos de edad avanzada con HIC, en individuos menores de 50 años también la HTA resulta ser el factor de riesgo dominante, aunque la diabetes, tabaquismo, el uso excesivo de alcohol y la cafeína (en bebidas y drogas) también parecen desempeñar un papel de relevancia.…”