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(Stroke. 2003;34:2065.)
© 2003 American Heart Association, Inc.

Comments, Opinions, and Reviews

Editorial Comment—Minor Risk Factors for Intracerebral Hemorrhage: The Jury Is Still Out

Epidemiology Division, National Stroke Research Institute, West Heidelberg, Victoria, Australia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Prevention of intracerebral hemorrhage (ICH) is still the most effective method for reducing the impact of this devastating disease. To facilitate better development of prevention programs, we need precise estimates of risk and elucidation of minor risk factors.

In the past, there have been some major difficulties surrounding the identification of risk factors for ICH. The first is that ICH is a relatively uncommon disease, making up between 10% and 15% of all strokes in Western countries.¹ Consequently, to ensure adequate cases of ICH, cohort studies must be very large, and patients must be accrued over many years. Alternatively, case-control methodology could be used and, if carefully conducted to reduce bias, may provide accurate results. Moreover, it is only since the CT era that ICH could be studied as a separate entity with diagnostic accuracy. Inclusion of cases with other types of stroke that have differing etiologies would result in a weakening of any associations identified.

To address some of the limitations of small data sets and diversity of risk factors studied, Ariesen and colleagues² have conducted a meta-analysis of previous work in this area. This is a timely analysis, given the number of publications in recent years. Apart from age and sex, they have confirmed that the most important risk factor for ICH is hypertension.^3–5 Despite different definitions of hypertension in these studies, the relationship between hypertension and ICH is clear. They have also confirmed an association between heavy alcohol consumption and ICH.^4,6,7 Further support for alcohol consumption as . . . [Full Text of this Article]