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[A nested case-control study of risk factors for intracerebral hemorrhage and cerebral infarction classified by
1Institute of Community Medicine, University of Tsukuba.
Insights
High blood pressure is a significant risk factor for all stroke types, including intracerebral hemorrhage (ICH) and cerebral infarction (CI). Different hypertension effects, acute for ICH and chronic for CI, are suggested by stroke type variations.
Area of Science:
- Neurology
- Epidemiology
- Cardiovascular Research
Context:
- Prospective study of 7,390 Japanese adults aged 40-69 without prior stroke.
- Follow-up conducted from 1975-1989 across three rural populations.
- Utilized computed tomography (CT) for stroke classification.
Purpose:
- To identify and compare risk factors for intracerebral hemorrhage (ICH) and cerebral infarction (CI).
- To investigate the relationship between hypertension duration and stroke subtype.
- To analyze associations between baseline variables and specific stroke types.
Summary:
- High blood pressure is linked to all stroke types (ICH, penetrating artery infarction, cortical artery infarction).
- Atrial fibrillation and ECG ST-T abnormalities are risk factors for cortical artery infarction.
- Hypertension's acute effects may cause ICH, while chronic effects contribute to CI subtypes.
Impact:
- Provides insights into differential risk factors for various stroke subtypes.
- Highlights the crucial role of blood pressure management in stroke prevention.
- Suggests distinct pathophysiological mechanisms for different stroke types based on hypertension duration.
Abstract:
Risk factors for intracerebral hemorrhage (ICH) and cerebral infarction (CI), were studied by a prospective study of 7,390 men and women aged 40-69 without a history of stroke living in three rural populations in Japan. Baseline examinations were done for populations in Akita-Ikawa and Akita-Ishizawa in 1975-1979, and for Ibaraki-Kyowa in 1981-1987, and followed until 1989 for Akita-Ikawa and Ibaraki-Kyowa and 1987 Akita-Ishizawa. There were 246 stroke cases diagnosed by clinical criteria during the follow-up period in which 74 percent (n = 181) had data from computed tomography (CT) performed within three weeks of the onset. According to these CT-findings, 181 stroke were classified as 48 with ICH, 50 with CI in penetrating artery regions (penetrating artery infarction), 33 with CI in cortical artery regions (cortical artery infarction), and 31 with subarachnoid hemorrhage while there were 19 with stroke without any evident CT abnormality. Cortical artery infarction was further classified as embolic type (n = 17) and thrombotic type (n = 9) according to clinical findings of the onset and presence of possible embolic sources such as atrial fibrillation, congenital heart disease, myocardial infarction and heart valve diseases. Using a nested case-control design, risk variables at baseline examination were compared between 131 stroke cases, 48 ICH and 83 CI, with 655 controls matched for sex, age (+/- 3), and the follow-up year. Univariate analysis showed that high blood pressure was associated with all types of stroke. From conditional logistic regression analysis significant risk variables were found to be high blood pressure for ICH and penetrating artery infarction, while atrial fibrillation and ST-T abnormality in electrocardiogram (ECG) were risk variables for cortical artery infarction. Associations with hypertensive or arteriosclerotic changes in ocular fundus were stronger for penetrating artery infarction than ICH and cortical artery infarction. ST-T abnormality in ECG was associated with embolic type cortical artery infarction and high blood pressure was associated with the thrombotic type, although the number of cases were small. Compared to controls, cortical artery infarction showed a higher mean value of serum total cholesterol for thrombotic type cortical infarction, and lower mean values for embolic type and ICH, but none of them reached statistical significance. The present study also suggests that duration of hypertension varied with type of stroke. ICH may develop due to acute effects of hypertension, while penetrating artery infarction and cortical artery infarction develop by chronic effects of hypertension.