Published Online
on August 4, 2005

A more recent version of this article appeared on September 1, 2005

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Submitted on February 9, 2005
Revised on April 5, 2005
Accepted on April 28, 2005

Major Risk Factors for Intracerebral Hemorrhage in the Young Are Modifiable

Edward Feldmann MD^*; Joseph P. Broderick MD; Walter N. Kernan MD; Catherine M. Viscoli PhD; Lawrence M. Brass MD; Thomas Brott MD; Lewis B. Morgenstern MD; Janet Lee Wilterdink MD; and Ralph I. Horwitz MD

From the Department of Clinical Neurosciences (E.F., J.L.W.), Brown Medical School, Providence, RI; Department of Neurology (J.P.B.), University of Cincinnati, Ohio; Departments of Internal Medicine (W.N.K., C.M.V., L.M.B.), Neurology (L.M.B.), and Epidemiology and Public Health (L.M.B.), Yale University School of Medicine, New Haven, Conn; Stroke Program (L.B.M.), University of Michigan, Ann Arbor; Mayo Medical School (T.B.), Rochester, Minn; and Case Western Reserve University School of Medicine (R.I.H.), Cleveland, Ohio.

^* To whom correspondence should be addressed. E-mail: EFeldmann{at}lifespan.org.

Background and Purpose--To identify risk factors for intracerebral hemorrhage (ICH), we examined data from the Hemorrhagic Stroke Project (HSP), a case-control study of hemorrhagic stroke among men and women aged 18 to 49 years.

Methods--Case subjects for the HSP were recruited from 44 hospitals in the United States. Eligibility criteria included an ICH within 30 days preceding enrollment, no history of stroke or known brain lesion. For this report, we focused on patients with primary ICH, defined as not associated with an aneurysm, arteriovenous malformation or other structural lesion. Two control subjects were sought for each case subject. A multivariate regression analysis was performed to determine risk factors for primary ICH.

Results--A total of 1714 patients with hemorrhagic stroke were identified for participation in the HSP. Of these, 217 cases met the criteria for primary ICH. Cases with primary ICH were matched to 419 controls. Independent risk factors for ICH included hypertension (adjusted odds ratio [OR], 5.71; 95% CI, 3.61 to 9.05), diabetes (adjusted OR, 2.40; 95% CI, 1.15 to 5.01), menopause (adjusted OR, 2.50; 95% CI, 1.06 to 5.88), current cigarette smoking (adjusted OR, 1.58; 95% CI, 1.02 to 2.44), alcoholic drinks2/day (adjusted OR, 2.23; 95% CI, 1.16 to 4.32), caffeinated drinks5/day (adjusted OR, 1.73; 95% CI, 1.08 to 2.79), and caffeine in drugs (adjusted OR, 3.55; 95% CI, 1.24 to 10.20).

Conclusions--Among young men and women, the major risk factors for primary ICH can be modified, suggesting that this type of stroke may be preventable. Our findings for caffeine and menopause warrant further study.

Key words: cerebral hemorrhage • risk factors

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