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Risk factors for primary intracerebral hemorrhage in patients in Izumo City, Japan

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Abstract

The annual incidence rate of primary intracerebral hemorrhage (ICH) in Izumo City, Japan, appears to be the highest rate among those reported. Despite improvement of management and surgical therapy, the overall morbidity and mortality after ICH are still high. The author investigated the risk factors for ICH in patients in Izumo. A case-control study of 242 patients (137 men and 105 women with ages ranging from 34 to 97 years) with primary ICH was conducted in Izumo between 1991 and 1998. Hypertension, diabetes mellitus, heart disease, liver disease, alcohol consumption, cigarette smoking, and serum levels of total cholesterol, aspartate aminotransferase, and alanine aminotransferase were assessed as possible risk factors for ICH by using conditional logistic regression. The prevalence of hypertension among ICH patients was 77% and the odds ratio (OR) for hypertension was 17.07 (95% CI: 8.30–35.09), which are much higher than figures reported from Western countries. The OR for hypertension was higher in individuals ≤69 years of age than in those ≥70 years of age and lower for lobar hemorrhage than for hemorrhages at other sites. High serum total cholesterol (≥220 mg/dl) was the second most important risk factor for ICH (OR: 2.52; 95% CI: 1.23–5.14), and low total cholesterol (<160 mg/dl) decreased the risk of ICH (OR: 0.47; 95% CI: 0.27–0.82). In contrast, heart disease decreased the risk of ICH, and there was no observed association between alcohol consumption, cigarette smoking, or diabetes mellitus and ICH. This study conducted in Izumo suggests that hypertension is the most important risk factor for ICH and contrary to most previous studies indicates that serum total cholesterol concentration is also positively associated with the risk of ICH. In contrast, heart disease may decrease the risk of ICH.

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Acknowledgement

I thank Dr. Tsukasa Nakamura for statistical analyses.

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Authors and Affiliations

  1. Department of Neurosurgery, Shimane Prefectural Central Hospital, Himebara 4-1-1, Izumo, Shimane, 693-8555, Japan

    Tetsuji Inagawa

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Correspondence to Tetsuji Inagawa.

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Comments

Tomokatsu Hori, Tokyo, Japan

This is a community-based retrospective study of risk factors for primary intracerebral hemorrhage in patients in Izumo City. In Japan the daily consumption of dietary salt has exceeded 10 g which is about three times higher than necessary (3 g) even now. One conclusion of this paper is that hypertension was the most important risk factor for ICH, regardless of age and sex, which is a reasonable result comparing it to the literature. Another finding is that hypercholesterolemia was associated with increased risk of ICH, and hypocholesterolemia reduced the risk of ICH. Concerning this finding of the relation between hypercholesterolemia and ICH, the author should perform a prospective control study to ascertain a final conclusion. Anyway, this is a community-based analysis of risk factors associated with ICH, and the results are interesting.

Comments

Kaoru Kurisu, Hiroshima, Japan

The author has been Head for a long time at the Department of Neurosurgery, Shimane Prefectural Central Hospital in Izumo City, which is located in the western part of Honshu, the biggest island of Japan, at the Sea of Japan. He has presented many highly qualified and excellent clinical papers on cerebrovascular diseases, especially the pathophysiology and treatment of subarachnoid hemorrhage, in journals famous worldwide like the Journal of Neurosurgery, Neurosurgery, Surgical Neurology, etc. This paper is concerned with the subject of his lifework on cerebrovascular diseases. He revealed the characteristics after analyzing various risk factors for intracerebral hemorrhage as a community-based clinical research in a restricted area. It is well known that Japan is a society with elderly people now, but in a future 10 years, 25% of Japanese people will become 65 years old or more. So, in Japan we have a special meeting for neurosurgery, Japan Geriatric Neurosurgery Society, every year. Shimane Prefecture is an area with a growing elderly population. In Japan the pattern of cerebrovascular disease has changed according to the change of lifestyle. It is crucial for people living in Japan to prevent or control hypertension, diabetes mellitus, hyperlipidemia, obesity and so on in order to have as few handicapped people as possible. As the author mentioned in his conclusions, the differences among races, sex, age, and locations of hemorrhage should be considered thoroughly.

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Inagawa, T. Risk factors for primary intracerebral hemorrhage in patients in Izumo City, Japan. Neurosurg Rev 30, 225–234 (2007). https://doi.org/10.1007/s10143-007-0082-8

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