The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and Hispanics

Labovitz, Daniel L.; Halim, Aris; Boden‐Albala, Bernadette; Hauser, W. Allen; Sacco, Ralph L.

doi:10.1212/01.wnl.0000172915.71933.00

Cited by 198 publications

(154 citation statements)

References 27 publications

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“…These findings are of particular interest because they persisted after adjustment for cardiovascular risk factors, which are often presumed to be the major driving factors behind health disparity in ICH recurrence/outcomes (especially for nonlobar ICH). 21,22 Other, still unidentified biological mechanisms may also contribute to ICH outcome disparity in these minority populations, thus warranting further in-depth investigation.…”

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confidence: 99%

APOE ε4 and lipid levels affect risk of recurrent nonlobar intracerebral hemorrhage

et al. 2015

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Objective: Genetic variants e2/e4 within the APOE gene are established risk factors for lobar intracerebral hemorrhage (ICH). Published preliminary data suggest a potential role for APOE e4 in risk of nonlobar ICH. We therefore investigated the role of APOE in recurrent nonlobar ICH, and sought to clarify whether effects of APOE on circulating lipids mediate this association.Methods: Three hundred sixty-three survivors of nonlobar ICH were followed prospectively for ICH recurrence, with APOE genotype determined at enrollment. All participants had clinical, demographic, and laboratory data captured at time of index ICH and during follow-up. Using a multivariate model, we performed association and interaction analyses of the relationships among APOE genotype, lipid levels, and recurrent nonlobar ICH. Results:We observed 29 nonlobar ICH recurrences among 363 survivors. APOE e4 was associated with recurrent nonlobar ICH (hazard ratio 5 1.31; 95% confidence interval 5 1.02-2.69; p 5 0.038) after adjustment for age/sex/ethnicity and cardiovascular risk factors. Increasing lowdensity lipoprotein (LDL) levels were associated with decreased risk of recurrent nonlobar ICH (p 5 0.027), as were decreasing HDL levels (p 5 0.046). LDL levels modified the association of APOE e4 with recurrent nonlobar ICH (mediation p , 0.05). No associations were identified between APOE e2 and recurrent nonlobar ICH.Conclusion: APOE e4 is associated with recurrent ICH in nonlobar brain regions, providing further evidence for its causal role in ICH unrelated to cerebral amyloid angiopathy. LDL levels modulated this effect, suggesting that circulating lipid levels may mediate a portion of the role of APOE e4 in nonlobar ICH. Neurology ® 2015;85:349-356 GLOSSARY CAA 5 cerebral amyloid angiopathy; CI 5 confidence interval; EMR 5 electronic medical record; HDL 5 high-density lipoprotein; HR 5 hazard ratio; ICH 5 intracerebral hemorrhage; IQR 5 interquartile range; LDL 5 low-density lipoprotein; TC 5 total cholesterol.Primary intracerebral hemorrhage (ICH) is the most lethal acute cerebrovascular disorder, its mortality rate ranging from 40% to 50% at 90 days from the initial bleeding event.1 Survivors are often burdened with substantial disability and face a high risk of recurrent ICH.2 Previous studies demonstrated that survivors of ICH in the lobar brain regions are at higher risk of recurrence, and multiple predictors of recurrent lobar ICH have been identified.3,4 Among these, the e2/e4 variants of the APOE gene are presumed to modify lobar ICH recurrence risk via their role in small vessel disease associated with cerebral amyloid angiopathy (CAA). 3,5 A recent, large meta-analysis of case-control studies conclusively demonstrated that APOE e2 and e4 increase risk of ICH in the lobar brain regions. 6 An intriguing preliminary finding that emerged as well was an association between APOE e4, but not e2, and nonlobar ICH.6 This finding warrants further exploration of its potential underlying biology, as nonlobar ICH is typically associate...

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APOE ε4 and lipid levels affect risk of recurrent nonlobar intracerebral hemorrhage

et al. 2015

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“…5,6 Prior reports from our group and others support the hypothesis that risk factors for ICH vary according to hemorrhage location. [7][8][9][10] The Genetic and Environmental Risk Factors in Hemorrhagic Stroke (GERFHS) Study is designed to examine the genetic and environmental variables associated with hemorrhagic stroke in the biracial population of the Greater Cincinnati/Northern Kentucky (GCNK) region (population 1.3 million, 16% black). In 2002, our preplanned interim analysis examined the hypothesis that risk factors for ICH varied according to hemorrhage location.…”

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confidence: 99%

Risk factors for intracerebral hemorrhage differ according to hemorrhage location

et al. 2012

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Objectives: Risk factors have been described for spontaneous intracerebral hemorrhage (ICH); their relative contribution to lobar vs nonlobar hemorrhage location is less clear. Our purpose here was to investigate risk factors by hemorrhage location.Methods: This case-control study prospectively enrolled subjects with first-ever spontaneous ICH and matched each with up to 3 controls by age, race, and gender. Conditional stepwise logistic regression modeling was used to determine significant independent risk factors for lobar and nonlobar ICH.Results: From December 1997 through December 2006, 597 cases and 1,548 controls qualified for the analysis. Hypertension, warfarin use, first-degree relative with ICH, personal history of ischemic stroke, less than a high school education, and APOE e2 or e4 genotype were more common in ICH cases. Hypercholesterolemia and moderate alcohol consumption (#2 drinks per day) were less common in ICH cases. The associations of hypertension and hypercholesterolemia were specific for nonlobar ICH. Conversely, the association of APOE e2 or e4 genotype was specific for lobar ICH.Conclusions: APOE e2 or e4 genotype was associated specifically with lobar ICH. Hypertension was associated specifically with nonlobar ICH. A protective association was seen between hypercholesterolemia and nonlobar ICH; no such association was identified for lobar ICH. Intracerebral hemorrhage (ICH) accounts for approximately 20% of strokes worldwide, with 30-day mortality estimates of 32%-50%. [1][2][3][4] Of patients who survive, only 28%-35% are independent at 3 months. 5,6 Prior reports from our group and others support the hypothesis that risk factors for ICH vary according to hemorrhage location.7-10 The Genetic and Environmental Risk Factors in Hemorrhagic Stroke (GERFHS) Study is designed to examine the genetic and environmental variables associated with hemorrhagic stroke in the biracial population of the Greater Cincinnati/Northern Kentucky (GCNK) region (population 1.3 million, 16% black). In 2002, our preplanned interim analysis examined the hypothesis that risk factors for ICH varied according to hemorrhage location. Hypertension had the highest attributable risk for nonlobar ICH (e.g., basal ganglia, thalamus, brainstem, cerebellum, or periventricular white matter), whereas APOE alleles e2 and e4 had the highest attributable risk for lobar ICH 7 -findings that have been replicated in other studies. [8][9][10] That report had a limited sample size and therefore limited ability to differentiate risk factors by subgroup. The current report, with over 3 times the sample size of our interim report, re-examines the hypothesis that risk factors for ICH vary in prevalence and attributable risk for lobar vs nonlobar ICH.METHODS Study design. GERFHS is a case-control study of hemorrhagic stroke that used population-based case ascertainment.

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“…ICH is more common in men than in women [3] and varies according to ethnic background. Individuals of African, Japanese, and Hispanic descent have a higher risk of ICH [4][5][6]. Blacks and Hispanics have been found to have double the risk of ICH compared to Caucasians [4,6].…”

Section: Introductionmentioning

confidence: 99%

“…Individuals of African, Japanese, and Hispanic descent have a higher risk of ICH [4][5][6]. Blacks and Hispanics have been found to have double the risk of ICH compared to Caucasians [4,6]. ICH continues to impart a considerable degree of morbidity and mortality, with 30-day mortality ranging from 44 to 50% [1,7,8].…”

Section: Introductionmentioning

confidence: 99%

Treatment Targets in Intracerebral Hemorrhage

Sangha

Gonzales

2011

Neurotherapeutics

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Intracerebral hemorrhage (ICH) imparts a higher mortality and morbidity than ischemic stroke. The therapeutic interventions that are currently available focus mainly on supportive care and secondary prevention. There is a paucity of evidence to support any one acute intervention that improves functional outcome. This chapter highlights current treatment targets for ICH based on the pathophysiology of the disease.

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The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and Hispanics

Abstract: ICH is a heterogeneous disease with deep and lobar subtypes distinguishable on an epidemiologic basis. The different patterns of these two subtypes in our race-ethnically diverse population lend credence to the notion that ICH should no longer be treated as a single entity.

Cited by 198 publications

References 27 publications

APOE ε4 and lipid levels affect risk of recurrent nonlobar intracerebral hemorrhage

APOE ε4 and lipid levels affect risk of recurrent nonlobar intracerebral hemorrhage

Risk factors for intracerebral hemorrhage differ according to hemorrhage location

Treatment Targets in Intracerebral Hemorrhage

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