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ABSTRACT
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 ε2 or ε4 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 ε2 or ε4 genotype was specific for lobar ICH.
Conclusions: APOE ε2 or ε4 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.
Glossary
- ARIC=
- Atherosclerosis Risk in Communities;
- CHS=
- Cardiovascular Health Studies;
- CI=
- confidence interval;
- GCNK=
- Greater Cincinnati/Northern Kentucky;
- GCNKSS=
- Greater Cincinnati/Northern Kentucky Stroke Study;
- GERFHS=
- Genetic and Environmental Risk Factors in Hemorrhagic Stroke;
- ICD-9=
- International Classification of Diseases, Ninth Revision;
- ICH=
- intracerebral hemorrhage;
- NHANES I=
- National Health and Nutrition Examination Survey;
- OR=
- odds ratio;
- SAH=
- subarachnoid hemorrhage
Footnotes
Study funding: Supported by NIH (National Institute of Neurological Disorders and Stroke: R-01-NS 36695 and T-32-NS 047996; NIEH: R-01- ES 06096).
Go to Neurology.org for full disclosures. Disclosures deemed relevant by the authors, if any, are provided at the end of this article.
Supplemental data at www.neurology.org
- Received March 6, 2012.
- Accepted August 9, 2012.
- © 2012 American Academy of Neurology
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