Risk factors for intraparenchymal hemorrhagic stroke and Twin-Cities area stroke trends

Stroke is an important cause of morbidity and mortality in the United States. Stroke mortality rates have been declining in the US for decades. Less is known about trends in stroke incidence rates, but some studies indicate a decline. Stroke case fatality has also been declining. Stroke subtype trends are not well studied. We examined the trends in mortality, attack rate, and case fatality of stroke by subtype in the Minneapolis-St Paul area from 1980-2002.;Total stroke mortality and hospital case fatality both declined by almost 50% over the study period, while the attack rate of hospitalized stroke was relatively stable. Ischemic stroke attack rate increased, while case fatality and mortality rates decreased. Case fatality and mortality rates declined for subarachnoid hemorrhage, while the attack rate was stable. Intracerebral hemorrhage attack rates increased minimally, case fatality declined, and the mortality rate was stable.;Relatively few prospective studies have reported risk factors for intraparenchymal hemorrhage (IPH) and results are inconsistent. We explored risk factors for IPH in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS).;The ARIC cohort was assembled in 1987-1989 and involves 15,792 men and women, aged 45-64 years at baseline, sampled from four U.S. communities. The CHS cohort was recruited in 1989-1993 and involves 5,888 men and women, aged 65 or over at baseline, sampled from four U.S. communities. Baseline measurements included many potential vascular risk factors. The cohorts were followed for incident stroke events.;Over 263,489 person-years of follow-up, 135 incident IPH strokes occurred. In a multivariable model, age, African-American ethnicity (versus whites), hypertension status, fibrinogen, Factor VIII, and von Willebrand factor were positively associated with incident IPH, while low-density lipoprotein cholesterol and triglycerides were inversely related to incident IPH. Sex, smoking, alcohol intake, body mass index, waist-to-hip ratio, waist circumference, Factor VII, white blood cell count, C-reactive protein, APOE genotype, and diabetes were not related to IPH.