Intracerebral hemorrhage incidence in older adults has increased

  • Lioutas VA & al.
  • JAMA Neurol
  • 8 Jun 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • During 1948-2016, the incidence of intracerebral hemorrhage (ICH) rose among adults aged ≥75 years.

Why this matters

  • Evidence is mixed regarding a temporal trend.

Key results

  • Primary ICH during 68-year follow-up:
    • 1.25% of patients.
    • Incidence rate: 43 cases per 100,000 person-years.
  • Age-adjusted incidence rate decreased slightly between 1987-1999 and 2000-2016.
  • ICH incidence (per 100,000 person-years) among adults ≥75 years increased over time:
    • 1948-1986: 88 cases.
    • 1987-1999: 158 cases.
    • 2000-2016: 176 cases.
  • Anticoagulant use also rose sharply (from 4.4% in 1987-1999 to 13.9% in 2000-2016).
  • Incidence rates for both deep and lobar ICH increased with age.
  • Risk factors for deep ICH:
    • Increasing systolic BP (OR, 1.02; P=.008).
    • Increasing diastolic BP (OR, 1.04; P=.01).
    • Statin use (OR, 4.07; P = .03).
  • Risk factors for lobar ICH:
    • Increasing systolic BP (OR, 1.02; P=.002).
    • Apolipoprotein E ε4 allele homozygosity (OR, 3.66; P=.02).

Study design

  • Prospective longitudinal community-based cohort study: 5209 original participants (age, 28-62 years), 5124 offspring participants (age, 5-70 years) from the Framingham Heart Study.
  • Main outcome: spontaneous ICH on imaging or pathologic testing.
  • Funding: National Institute of Neurological Disorders and Stroke.

Limitations

  • Population was mainly white.
  • Data on antithrombotic medications, neuroimaging markers limited.
  • Lack of power to assess long-term cognitive effect, medication-risk factor interactions.