Risk Factors for Lobar and Non-Lobar Intracerebral Hemorrhage in Patients with Vascular Disease

Kremer, Philip H. C.; Jolink, Wilmar M.T.; Kappelle, L. Jaap; Algra, Ale; Klijn, Catharina J.M.; Groups, Esprit Study

doi:10.1371/journal.pone.0142338

Cited by 25 publications

(20 citation statements)

References 30 publications

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“…Second, selection bias may play a role in that patients with a poor prognosis may have died before informed consent could be obtained. The sample size of patients with sICH was limited and we were therefore unable to distinguish lobar from nonlobar sICH, which have different risk profiles . Third, assessment of IS caused by SVD may have been prone to misclassification since, according to TOAST, support from imaging is not required.…”

Section: Discussionmentioning

confidence: 99%

Age‐Specific Vascular Risk Factor Profiles According to Stroke Subtype

Hauer

Ruigrok

Algra

et al. 2017

JAHA

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BackgroundIschemic and hemorrhagic stroke are increasingly recognized as heterogeneous diseases with distinct subtypes and etiologies. Information on variation in distribution of vascular risk factors according to age in stroke subtypes is limited. We investigated the prevalence of vascular risk factors in stroke subtypes in relation to age.Methods and ResultsWe studied a prospective multicenter university hospital–based cohort of 4033 patients. For patients with ischemic stroke caused by large artery atherosclerosis, small vessel disease, or cardioembolism and for patients with spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage, we calculated prevalences of vascular risk factors in 4 age groups: <55, 55 to 65, 65 to 75, and ≥75 years, and mean differences with 95% CIs in relation to the reference age group. Patients aged <55 years were significantly more often of non‐white origin (in particular in spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage patients) and most often smoked (most prominent for aneurysmal subarachnoid hemorrhage patients). Patients aged <55 years with ischemic stroke caused by large artery atherosclerosis or small vessel disease more often had hypertension, hyperlipidemia, and diabetes mellitus than patients with ischemic stroke of cardiac origin. Overall, the frequency of hypertension, hyperlipidemia, and diabetes mellitus increased with age among all stroke subtypes, whereas smoking decreased with age. Regardless of age, accumulation of potentially modifiable risk factors was most pronounced in patients with ischemic stroke caused by large artery atherosclerosis or small vessel disease.ConclusionsThe prevalence of common cardiovascular risk factors shows different age‐specific patterns among various stroke subtypes. Recognition of these patterns may guide tailored stroke prevention efforts aimed at specific risk groups.

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Section: Discussionmentioning

confidence: 99%

Age‐Specific Vascular Risk Factor Profiles According to Stroke Subtype

Hauer

Ruigrok

Algra

et al. 2017

JAHA

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“…Previous studies have found that lobar localization, often seen in patients with cerebral amyloid angiopathy (CAA), is associated with recurrence. [8,19,31] The diagnosis CAA is not consistently registered, thus we were not able to investigate or adjust for it. As CAA is associated with elderly age, the missing information could potentially confound the results, and partially explain the high recurrence risk seen with elderly age after one year.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Intracerebral Hemorrhage: Associations with Comorbidities and Medicine with Antithrombotic Effects

et al. 2016

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BackgroundIntracerebral hemorrhage (ICH) is a disease with high mortality and a substantial risk of recurrence. However, the recurrence risk is poorly documented and the knowledge of potential predictors for recurrence among co-morbidities and medicine with antithrombotic effect is limited.Objectives1) To estimate the short- and long-term cumulative risks of recurrent intracerebral hemorrhage (ICH). 2) To investigate associations between typical comorbid diseases, surgical treatment, use of medicine with antithrombotic effects, including antithrombotic treatment (ATT), selective serotonin reuptake inhibitors (SSRI’s), and nonsteroidal anti-inflammatory drugs (NSAID’s) with recurrent ICH.MethodsThe cohort consisted of all individuals diagnosed with a primary ICH in Denmark 1996–2011. Information on comorbidities, surgical treatment for the primary ICH, and the use of ATT, SSRI’s and NSAID’s was retrieved from the Danish national health registers. The cumulative recurrence risk of ICH was estimated using the Aalen-Johansen estimator, thus taking into account the competing risk of death. Associations with potential predictors of recurrent ICH were estimated as rate ratios (RR’s) using Poisson regression. Propensity score matching was used for the analyses of medicine with antithrombotic effects.ResultsAmong 15,270 individuals diagnosed with a primary ICH, 2,053 recurrences were recorded, resulting in cumulative recurrence risk of 8.9% after one year and 13.7% after five years. Surgical treatment and renal insufficiency were associated with increased recurrence risks (RR 1.64, 95% CI 1.39–1.93 and RR 1.72, 95% CI 1.34–2.17, respectively), whereas anti-hypertensive treatment was associated with a reduced risk (RR 0.82, 95% CI 0.74–0.91). We observed non-significant associations between the use of any of the investigated medicines with antithrombotic effect (ATT, SSRI’s, NSAID’s) and recurrent ICH.ConclusionsThe substantial short-and long-term recurrence risks warrant aggressive management of hypertension following a primary ICH, particularly in patients treated surgically for the primary ICH, and patients with renal insufficiency.

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“…As one might expect, the underlying pathologies correlate with specific anatomical locations of the hemorrhage (Fazekas et al, 1999; Woo et al, 2002; Xiong et al, 2016). ICH is thought to be the result of SVD in up to 85% of hemorrhagic stroke patients, due to hypertensive arteriopathy-induced rupture of small arterioles in non-lobar regions, such as the basal ganglia, thalamus, cerebellum and brainstem (Kremer et al, 2015). However, a fairly large proportion of lobar ICHs result from rupture of small and medium-sized arteries in the elderly, due to accumulation of amyloid-beta in both cortical blood vessels and leptomeninges (Kremer et al, 2015).…”

Section: Age-related Vcidmentioning

confidence: 99%

“…ICH is thought to be the result of SVD in up to 85% of hemorrhagic stroke patients, due to hypertensive arteriopathy-induced rupture of small arterioles in non-lobar regions, such as the basal ganglia, thalamus, cerebellum and brainstem (Kremer et al, 2015). However, a fairly large proportion of lobar ICHs result from rupture of small and medium-sized arteries in the elderly, due to accumulation of amyloid-beta in both cortical blood vessels and leptomeninges (Kremer et al, 2015). Consistent with this view, CAA accounts for the majority of lobar ICH in the elderly (Greenberg, 1998; Hernandez-Guillamon et al, 2012; Knudsen et al, 2001), and is significantly associated with lobar and cerebellar ICH but not with deep ICH (Samarasekera et al, 2012; Yamada, 2015).…”

Section: Age-related Vcidmentioning

confidence: 99%

The impact of cerebrovascular aging on vascular cognitive impairment and dementia

Yang

Sun

et al. 2017

Ageing Research Reviews

158

128

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As human life expectancy rises, the aged population will increase. Aging is accompanied by changes in tissue structure, often resulting in functional decline. For example, aging within blood vessels contributes to a decrease in blood flow to important organs, potentially leading to organ atrophy and loss of function. In the central nervous system, cerebral vascular aging can lead to loss of the integrity of the blood-brain barrier, eventually resulting in cognitive and sensorimotor decline. One of the major of types of cognitive dysfunction due to chronic cerebral hypoperfusion is vascular cognitive impairment and dementia (VCID). In spite of recent progress in clinical and experimental VCID research, our understanding of vascular contributions to the pathogenesis of VCID is still very limited. In this review, we summarize recent findings on VCID, with a focus on vascular age-related pathologies and their contribution to the development of this condition.

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Risk Factors for Lobar and Non-Lobar Intracerebral Hemorrhage in Patients with Vascular Disease

Cited by 25 publications

References 30 publications

Age‐Specific Vascular Risk Factor Profiles According to Stroke Subtype

Age‐Specific Vascular Risk Factor Profiles According to Stroke Subtype

Recurrent Intracerebral Hemorrhage: Associations with Comorbidities and Medicine with Antithrombotic Effects

The impact of cerebrovascular aging on vascular cognitive impairment and dementia

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