Background: Black and Hispanic Americans have a greater risk of primary intracerebral hemorrhage (ICH) than whites. Deep ICH is most often associated with hypertension, while lobar ICH is associated with cerebral amyl...Background: Black and Hispanic Americans have a greater risk of primary intracerebral hemorrhage (ICH) than whites. Deep ICH is most often associated with hypertension, while lobar ICH is associated with cerebral amyloid angiopathy. The authors conducted a population-based incidence study to directly compare the incidence of deep vs lobar ICH in all three raceethnic groups. Methods: The authors used an active hospital and community surveillance program and autopsy reports to identify incident ICH cases among white, black, and Caribbean Hispanic adults in Northern Manhattan between July 1993 and June 1997. Incidence rates were adjusted for age and sex to the 1990 US Census. CIs for risk ratios (RR) were calculated with Byar’s χ2 approximation of the Poisson distribution. Results: The authors identified 155 cases of ICH for an annual incidence of 30.9/100,000 (26.7 to 35.0). Men had a higher risk of ICH than women (RR 1.5, 95%CI 1.2 to 1.8), driven entirely by the incidence of deep ICH (RR 1.8) rather than lobar ICH (RR 1.0). Compared with whites, RR for blacks was all ICH 3.8 (2.2 to 8.9), deep 4.8 (2.3 to 21.1), lobar 2.8 (1.2 to 14.4); RR for Hispanics was all 2.6 (1.4 to 6.1), deep 3.7 (1.7 to 16.5), lobar 1.4 (0.4 to 7.4). Conclusions: ICH is a heterogeneous disease with deep and lobar subtypes distinguishable on an epidemiologic basis. The different patterns of these two subtypes in our race-ethnically diverse population lend credence to the notion that ICH should no longer be treated as a single entity.展开更多
Background: Atherosclerosis is an inflammatory disease, and leukocyte levels are associated with future risk of ischemic cardiac disease. Objective: To inves tigate the hypothesis that relative elevations in leukocyte...Background: Atherosclerosis is an inflammatory disease, and leukocyte levels are associated with future risk of ischemic cardiac disease. Objective: To inves tigate the hypothesis that relative elevations in leukocyte count in a stroke- free population predict future ischemic stroke (IS). Methods: A populationbased prospective cohort study was performed in a multiethnic urban population. Stroke - free community participants were identified by random- digit dialing. Leukoc yte levels were measured at enrollment, and participants were followed annually for IS, myocardial infarction (MI), and cause- specific mortality. Cox proporti onal hazards regression models were used to calculate hazard ratios (HRs) and 95 % CIs for IS, MI, and vascular death after adjustment for medical, behavioral, and socioeconomic factors. Results: Among 3,103 stroke- free community partici pants (mean age 69.2 ± 10.3 years) with baseline leukocyte levels measured, med ian follow- up was 5.2 years. After adjusting for stroke risk factors, each SD in leukocyte count (1.8 × 109 cells/L) was associated with an increased risk of IS (HR 1.22, 95% CI 1.05 to 1.42), and IS, MI, or vascular death (HR 1.13, 95 % CI 1.02 to 1.26). Compared with those in the lowest quartile of leukocyte co unt, those in the highest had an increased risk of IS (adjusted HR 1.75, 95% C I 1.08 to 2.82). The effect on atherosclerotic and cardioembolic stroke was grea ter than in other stroke subtypes. Conclusion: Relative elevations in leukocyte count are independently associated with an increased risk of future ischemic str oke and other cardiovascular events.展开更多
文摘Background: Black and Hispanic Americans have a greater risk of primary intracerebral hemorrhage (ICH) than whites. Deep ICH is most often associated with hypertension, while lobar ICH is associated with cerebral amyloid angiopathy. The authors conducted a population-based incidence study to directly compare the incidence of deep vs lobar ICH in all three raceethnic groups. Methods: The authors used an active hospital and community surveillance program and autopsy reports to identify incident ICH cases among white, black, and Caribbean Hispanic adults in Northern Manhattan between July 1993 and June 1997. Incidence rates were adjusted for age and sex to the 1990 US Census. CIs for risk ratios (RR) were calculated with Byar’s χ2 approximation of the Poisson distribution. Results: The authors identified 155 cases of ICH for an annual incidence of 30.9/100,000 (26.7 to 35.0). Men had a higher risk of ICH than women (RR 1.5, 95%CI 1.2 to 1.8), driven entirely by the incidence of deep ICH (RR 1.8) rather than lobar ICH (RR 1.0). Compared with whites, RR for blacks was all ICH 3.8 (2.2 to 8.9), deep 4.8 (2.3 to 21.1), lobar 2.8 (1.2 to 14.4); RR for Hispanics was all 2.6 (1.4 to 6.1), deep 3.7 (1.7 to 16.5), lobar 1.4 (0.4 to 7.4). Conclusions: ICH is a heterogeneous disease with deep and lobar subtypes distinguishable on an epidemiologic basis. The different patterns of these two subtypes in our race-ethnically diverse population lend credence to the notion that ICH should no longer be treated as a single entity.
文摘Background: Atherosclerosis is an inflammatory disease, and leukocyte levels are associated with future risk of ischemic cardiac disease. Objective: To inves tigate the hypothesis that relative elevations in leukocyte count in a stroke- free population predict future ischemic stroke (IS). Methods: A populationbased prospective cohort study was performed in a multiethnic urban population. Stroke - free community participants were identified by random- digit dialing. Leukoc yte levels were measured at enrollment, and participants were followed annually for IS, myocardial infarction (MI), and cause- specific mortality. Cox proporti onal hazards regression models were used to calculate hazard ratios (HRs) and 95 % CIs for IS, MI, and vascular death after adjustment for medical, behavioral, and socioeconomic factors. Results: Among 3,103 stroke- free community partici pants (mean age 69.2 ± 10.3 years) with baseline leukocyte levels measured, med ian follow- up was 5.2 years. After adjusting for stroke risk factors, each SD in leukocyte count (1.8 × 109 cells/L) was associated with an increased risk of IS (HR 1.22, 95% CI 1.05 to 1.42), and IS, MI, or vascular death (HR 1.13, 95 % CI 1.02 to 1.26). Compared with those in the lowest quartile of leukocyte co unt, those in the highest had an increased risk of IS (adjusted HR 1.75, 95% C I 1.08 to 2.82). The effect on atherosclerotic and cardioembolic stroke was grea ter than in other stroke subtypes. Conclusion: Relative elevations in leukocyte count are independently associated with an increased risk of future ischemic str oke and other cardiovascular events.
