Purpose: In this population-based study, risk factors for primary intracerebral hemorrhage (PICH) and PICH subtypes were explored in a nested case-control design. Method: Risk factors were determined in 22,444 men and 10,902 women (mean age 47 years) who participated in a health-screening programme between 1974 and 1991. 147 subjects with CT or autopsy-verified first-ever PICH during the follow-up period (mean 14 years) were compared with 1,029 stroke-free controls, matched for age, sex and screening-year. Results: As compared to controls, PICH cases had significantly higher blood pres- sure (135/91 vs. 127/85 mm Hg), triglycerides (1.7 vs. 1.4 mmol/l), BMI (25.5 vs. 24.8) and shorter stature (1.73 vs. 1.74 m). Diabetes (6.9 vs. 2.8 %) and history of psychiatric morbidity (19.7 vs. 11.0 %) were more common in PICH cases and more of them were living alone (35.4 vs. 25.5%). After adjustment in a backward logistic regression model, high systolic blood pressure, diabetes, high triglycerides, short stature and psychiatric morbidity remained significantly associated with PICH. As compared to the control group, high systolic blood pressure was significantly associated both with nonlobar and lobar PICH. Diabetes and psychiatric morbidity were associated with nonlobar PICH. Smoking doubled the risk for lobar PICH, but was unrelated to nonlobar PICH. Conclusion: In this prospective population-based study, hypertension, diabetes, height, triglycerides and psychiatric morbidity were risk factors for PICH. Smoking was a risk factor for lobar PICH only.

Keywords:
Primary intracerebral hemorrhage, Risk factors, Stroke
1.
Khan FA, Engstrom G, Jerntorp I, Pessah-Rasmussen H, Janzon L: Seasonal patterns of incidence and case fatality of stroke in Malmo, Sweden: the STROMA study. Neuroepidemiology 2005;24:26–31.
2.
Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP: Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke 1993;24:796–800.
3.
Eriksson SE, Olsson JE: Survival and recurrent strokes in patients with different subtypes of stroke: a fourteen-year follow-up study. Cerebrovasc Dis 2001;12:171–180.
4.
Brott T, Thalinger K, Hertzberg V: Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 1986;17:1078–1083.
5.
Saloheimo P, Juvela S, Hillbom M: Use of aspirin, epistaxis, and untreated hypertension as risk factors for primary intracerebral hemorrhage in middle-aged and elderly people. Stroke 2001;32:399–404.
6.
Thrift AG, McNeil JJ, Forbes A, Donnan GA: Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS) Group. Stroke 1996;27:2020–2025.
7.
Ariesen MJ, Claus SP, Rinkel GJ, Algra A: Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 2003;34:2060–2065.
8.
Thrift AG, McNeil JJ, Donnan GA: The risk of intracerebral haemorrhage with smoking. The Melbourne Risk Factor Study Group. Cerebrovasc Dis 1999;9:34–39.
9.
Karapanayiotides T, Piechowski-Jozwiak B, van Melle G, Bogousslavsky J, Devuyst G: Stroke patterns, etiology, and prognosis in patients with diabetes mellitus. Neurology 2004;62:1558–1562.
10.
Tanaka H, Ueda Y, Hayashi M, Date C, Baba T, Yamashita H, Shoji H, Tanaka Y, Owada K, Detels R: Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community. Stroke 1982;13:62–73.
11.
Yano K, Reed DM, MacLean CJ: Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program. Stroke 1989;20:1460–1465.
12.
Engstrom G, Khan FA, Zia E, Jerntorp I, Pessah-Rasmussen H, Norrving B, Janzon L: Marital dissolution is followed by an increased incidence of stroke. Cerebrovasc Dis 2004;18:318–324.
13.
Gillum RF, Mussolino ME, Ingram DD: Physical activity and stroke incidence in women and men: The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 1996;143:860–869.
14.
Jonas BS, Mussolino ME: Symptoms of depression as a prospective risk factor for stroke. Psychosom Med 2000;62:463–471.
15.
Kase CS, Williams JP, Wyatt DA, Mohr JP: Lobar intracerebral hematomas: clinical and CT analysis of 22 cases. Neurology 1982;32:1146–1150.
16.
Ropper AH, Davis KR: Lobar cerebral hemorrhages: acute clinical syndromes in 26 cases. Ann Neurol 1980;8:141–147.
17.
Woo D, Sauerbeck LR, Kissela BM, Khoury JC, Szaflarski JP, Gebel J, Shukla R, Pancioli AM, Jauch EC, Menon AG, Deka R, Carrozzella JA, Moomaw CJ, Fontaine RN, Broderick JP: Genetic and environmental risk factors for intracerebral hemorrhage: preliminary results of a population-based study. Stroke 2002;33:1190–1195.
18.
Nilsson OG, Lindgren A, Stahl N, Brandt L, Saveland H: Incidence of intracerebral and subarachnoid haemorrhage in southern Sweden. J Neurol Neurosurg Psychiatry 2000;69:601–607.
19.
Lipton RB, Berger AR, Lesser ML, Lantos G, Portenoy RK: Lobar vs thalamic and basal ganglion hemorrhage: clinical and radiographic features. J Neurol 1987;234:86–90.
20.
Passero S, Burgalassi L, D’Andrea P, Battistini N: Recurrence of bleeding in patients with primary intracerebral hemorrhage. Stroke 1995;26:1189–1192.
21.
Rodriguez BL, D’Agostino R, Abbott RD, Kagan A, Burchfiel CM, Yano K, Ross GW, Silbershatz H, Higgins MW, Popper J, Wolf PA, Curb JD: Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham Study: a comparison of incidence and risk factor effects. Stroke 2002;33:230–236.
22.
Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP: Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke 1999;30:2535–2540.
23.
Kurth T, Kase CS, Berger K, Gaziano JM, Cook NR, Buring JE: Smoking and risk of hemorrhagic stroke in women. Stroke 2003;34:2792–2795.
24.
Suh I, Jee SH, Kim HC, Nam CM, Kim IS, Appel LJ: Low serum cholesterol and haemorrhagic stroke in men: Korea Medical Insurance Corporation Study. Lancet 2001;357:922–925.
25.
Berglund G, Eriksson KF, Israelsson B, Kjellstrom T, Lindgarde F, Mattiasson I, Nilsson JA, Stavenow L: Cardiovascular risk groups and mortality in an urban Swedish male population: the Malmo Preventive Project. J Intern Med 1996;239:489–497.
26.
Janzon E, Hedblad B, Berglund G, Engstrom G: Tobacco and myocardial infarction in middle-aged women: a study of factors modifying the risk. J Intern Med 2004;256:111–118.
27.
Engstrom G, Lind P, Hedblad B, Stavenow L, Janzon L, Lindgarde F: Effects of cholesterol and inflammation-sensitive plasma proteins on incidence of myocardial infarction and stroke in men. Circulation 2002;105:2632–2637.
28.
Jerntorp P, Berglund G: Stroke registry in Malmo, Sweden. Stroke 1992;23:357–361.
29.
Merlo J, Lindblad U, Pessah-Rasmussen H, Hedblad B, Rastam J, Isacsson SO, Janzon L, Rastam L: Comparison of different procedures to identify probable cases of myocardial infarction and stroke in two Swedish prospective cohort studies using local and national routine registers. Eur J Epidemiol 2000;16:235–243.
30.
Peterson B, Trell E, Kristenson H: Comparison of gamma-glutamyltransferase and questionnaire test as alcohol indicators in different risk groups. Drug Alcohol Depend 1983;11:279–286.
31.
Population and Housing Census 1990: Stockholm, Statistics Sweden. ISBN 91-618-0406-1.
32.
Iribarren C, Jacobs DR, Sadler M, Claxton AJ, Sidney S: Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program. Stroke 1996;27:1993–1998.
33.
Kurth T, Kase CS, Berger K, Schaeffner ES, Buring JE, Gaziano JM: Smoking and the risk of hemorrhagic stroke in men. Stroke 2003;34:1151–1155.
34.
Lukovits TG, Mazzone TM, Gorelick TM: Diabetes mellitus and cerebrovascular disease. Neuroepidemiology 1999;18:1–14.
35.
McCarron P, Hart CL, Hole D, Smith GD: The relation between adult height and haemorrhagic and ischaemic stroke in the Renfrew/Paisley study. J Epidemiol Community Health 2001;55:404–405.
36.
1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension: Guidelines Subcommittee. J Hypertens 1999;17:151–183.
37.
Li C, Engstrom G, Hedblad B, Berglund G, Janzon L: Blood pressure control and risk of stroke: a population-based prospective cohort study. Stroke 2005;36:725–730.
38.
Woo D, Kissela BM, Khoury JC, Sauerbeck LR, Haverbusch MA, Szaflarski JP, Gebel JM, Pancioli AM, Jauch EC, Schneider A, Kleindorfer D, Broderick JP: Hypercholesterolemia, HMG-CoA reductase inhibitors, and risk of intracerebral hemorrhage: a case-control study. Stroke 2004;35:1360–1364.
39.
Ko NU, Johnston SC, Young WL, Singh V, Klatsky AL: Distinguishing intracerebral hemorrhages caused by arteriovenous malformations. Cerebrovasc Dis 2003;15:206–209.
40.
Janzon E, Hedblad B, Berglund G, Engstrom G: Changes in blood pressure and body weight following smoking cessation in women. J Intern Med 2004;255:266–272.
41.
Juvela S, Poussa K, Porras M: Factors affecting formation and growth of intracranial aneurysms: a long-term follow-up study. Stroke 2001;32:485–491.
42.
May M, McCarron P, Stansfeld S, Ben-Shlomo Y, Gallacher J, Yarnell J, Davey Smith G, Elwood P, Ebrahim S: Does psychological distress predict the risk of ischemic stroke and transient ischemic attack? The Caerphilly Study. Stroke 2002;33:7–12.
43.
Anda RF, Williamson DF, Escobedo LG, Mast EE, Giovino GA, Remington PL: Depression and the dynamics of smoking: a national perspective. JAMA 1990;264:1541–1545.
44.
McCreadie RG: Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry 2003;183:534–539.
© 2006 S. Karger AG, Basel
2006
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.