Published Online
on June 5, 2008

A more recent version of this article appeared on August 1, 2008

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Submitted on September 28, 2007
Revised on December 20, 2007
Accepted on January 24, 2008

Hemostatic and Inflammatory Risk Factors for Intracerebral Hemorrhage in a Pooled Cohort

Jared D. Sturgeon PhD; Aaron R. Folsom MD, MPH^*; W. T. Longstreth Jr MD, MPH; Eyal Shahar MD, MPH; Wayne D. Rosamond PhD; and Mary Cushman MD, MSc

From the Division of Epidemiology & Community Health (J.D.S., A.R.F.), University of Minnesota, Minneapolis; the Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; the Division of Epidemiology & Biostatistics (E.S.), Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson; the Department of Epidemiology (W.D.R.), University of North Carolina, Chapel Hill; and the Departments of Medicine and Pathology (M.C.), University of Vermont, Colchester.

^* To whom correspondence should be addressed. E-mail: folso001{at}umn.edu.

Background and Purpose—The purpose of this study was to identify novel risk factors for intracerebral hemorrhagic stroke (ICH).

Methods—Risk factors were assessed at baseline in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS) involving 21 680 adults aged 45 or over. Over 263 489 person-years of follow-up, we identified 135 incident ICH events.

Results—In multivariable models, for each SD higher baseline level of fibrinogen, the relative rate of incident ICH increased 35% (95% CI, 17% to 55%). Fibrinogen was more strongly related to ICH in ARIC than in CHS. In multivariable models, those with von Willebrand factor levels above the median were 1.72 (95% CI, 0.97 to 3.03) times more likely to have an incident ICH as those below the median. Factor VIII was significantly positively related to ICH in ARIC (relative rate per standard deviation of 1.31; 95% CI, 1.07 to 1.62), but not in CHS. There was no relation in multivariable models between lipoprotein (a), Factor VII, white blood cell count, or C-reactive protein and ICH.

Conclusions—Greater plasma fibrinogen and, to some degree, von Willebrand factor were associated with increased rates of ICH in these prospective studies, whereas Factor VIII was related to ICH in younger ARIC study participants only.

Key words: risk factors in epidemiology • intracerebral hemorrhage • cohort studies • incidence studies

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