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Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS)
A G Thrift1, J J McNeil, A Forbes
1Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Australia. thrift@austin.unimelb.edu.au
Insights
Hypertension significantly increases intracerebral hemorrhage risk, but aspirin-like drugs do not raise this risk. This study clarifies risk factors for brain bleeds.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Hypertension management has improved, and antiplatelet agent use has risen.
- Intracerebral hemorrhage (ICH) remains a significant concern.
Purpose of the Study:
- To investigate the association between hypertension and ICH risk.
- To determine if antiplatelet agent use increases ICH risk.
Main Methods:
- A city-wide case-control study involving 331 primary ICH cases and matched population controls.
- Data collected via questionnaires on risk factors.
Main Results:
- Hypertension approximately doubled the risk of ICH (OR, 2.55).
- Aspirin-like drug use was not associated with increased ICH risk (OR, 0.66).
- Reduced ICH risk observed with cardiovascular disease history, arthritis, high cholesterol, moderate overweight, hormone replacement therapy, and coffee consumption.
Conclusions:
- Hypertension is the primary risk factor for ICH, with a lower risk than previously reported.
- No evidence links aspirin-like drug use to an increased risk of ICH.
Background And Purpose:
Given that hypertension is now relatively well controlled and use of antiplatelet agents has increased, our primary aims were to investigate the risk of intracerebral hemorrhage (ICH) associated with hypertension and use of antiplatelet agents.
Methods:
In this city-wide case-control study, 370 consecutive cases of primary ICH, verified by CT or autopsy, were identified from one of 13 Melbourne hospitals. Ten subjects (or their next of kin) could not be located and 29 refused to participate, resulting in 331 eventual cases. Patients were aged between 18 and 80 years and had no prior stroke. Population-based control subjects were individually age- (+/- 5 years), sex-, and geographically matched to subject cases. A questionnaire administered to participants (or next of kin) elicited information about prior exposure to various potential risk factors.
Results:
Hypertension approximately doubled the risk of ICH (odds ratio, 2.55; 95% confidence interval, 1.72 to 3.79). The use of aspirinlike drugs, in doses used for secondary prevention of ischemic stroke or cardiac disease, was not associated with an increased risk of ICH (odds ratio, 0.66; 95% confidence interval, 0.20 to 2.21). Factors associated with a reduced risk of ICH were a history of cardiovascular disease, arthritis, or high cholesterol level; being moderately overweight or using hormone replacement therapy; and drinking coffee.
Conclusions:
Hypertension was the most important risk factor for ICH but not as high as previously reported, nor was it higher than that reported for ischemic stroke. There was no evidence for any association between the use of aspirinlike drugs and ICH.