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Age-dependent effect of susceptibility factors on the risk of intracerebral haemorrhage: Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy)
  1. Martina Locatelli1,
  2. Mario Grassi2,
  3. Valentina Saba2,
  4. Licia Iacovello3,4,
  5. Augusto di Castelnuovo4,
  6. Giovanni de Gaetano4,
  7. Marialuisa Zedde5,
  8. Simona Marcheselli6,
  9. Giorgio silvestrelli7,
  10. Alfonso Ciccone7,
  11. Maria Luisa Delodovici8,
  12. Lucia Princiotta Cariddi8,
  13. Alessia giossi9,
  14. Andrea Zini10,
  15. Maurizio Paciaroni11,
  16. Monica Acciarresi11,
  17. Cristiano Azzini12,
  18. Alessandro De Vito12,
  19. Massimo Gamba13,
  20. Mauro Magoni13,
  21. Massimo del Sette14,
  22. Antonella Toriello15,
  23. Carlo Gandolfo16,
  24. Cinzia Finocchi16,
  25. Domenico Marco Bonifati17,
  26. Rossana Tassi18,
  27. Giuseppe Martini18,
  28. Anna Cavallini19,
  29. Andrea Morotti20,
  30. sonia bonacina1,
  31. Valentina Mazzoleni1,
  32. Debora Pezzini1,
  33. Alberto Chiti21,
  34. Rocco Salvatore Calabrò22,
  35. Rosa Musolino23,
  36. Paolo La Spina23,
  37. Francesco Grillo23,
  38. Giampaolo Tomelleri24,
  39. Corrado Lodigiani25,
  40. Marco Ritelli26,
  41. Marina Colombi26,
  42. Alessandro Padovani1,
  43. Alessandro Pezzini1
  44. on behalf of the Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy) Investigators
  1. 1 Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
  2. 2 Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, University of Pavia, Pavia, Italy
  3. 3 Università dell'Insubria, Varese, Italia
  4. 4 Dipartimento di Epidemiologia e Prevenzione, NEUROMED, Pozzilli, Italia
  5. 5 S.C. Neurologia, Stroke Unit, Università di Modena e Reggio Emilia, Reggio Emilia, Italia
  6. 6 Neurologia d’Urgenza and Stroke Unit, IRCCS Humanitas Group, Rozzano, Italia
  7. 7 Stroke Unit, Dipartimento di Neuroscienze, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italia
  8. 8 Unità di Neurologia, Ospedale di Circolo, Università dell'Insubria, Varese, Italia
  9. 9 UO Neurologia, Azienda Ospedaliera Istituti Ospedalieri di Cremona, Cremona, Italia
  10. 10 Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, IRCCS Policlinico Sant'Orsola-Malpighi Università di Bologna, Bologna, Italia
  11. 11 Stroke Unit and Divisione di Medicina Cardiovascolare, Università degli Studi di Perugia, Perugia, Italia
  12. 12 Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Università di Ferrara, Ferrara, Italia
  13. 13 Stroke Unit, Neurologia Vascolare, ASST Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italia
  14. 14 Unità di Neurologia, EO Ospedali Galliera, Genova, Italia
  15. 15 UOC Neurologia, Università degli Studi di Salerno Facoltà di Medicina e Chirurgia, Salerno, Italia
  16. 16 Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genova, Italia
  17. 17 UO Neurologia, Azienda ULSS 9 Treviso, Treviso, Italia
  18. 18 Stroke Unit, AOU Senese, Siena, Italia
  19. 19 Stroke Unit, IRCCS "C. Mondino", Pavia, Italia
  20. 20 UOC Neurologia, ASST Azienda Ospedaliera Spedali Civili, Brescia, Italia
  21. 21 Neurologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italia
  22. 22 Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino Pulejo, Messina, Italia
  23. 23 Dipartimento di Medicina Clinica e Sperimentale, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina Facoltà di Medicina e Chirurgia, Messina, Italia
  24. 24 USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italia
  25. 25 UOC Centro Trombosi e Malattie Emorragiche, IRCCS Humanitas Group, Rozzano, Italia
  26. 26 Sezione di Biologia e Genetica, Dipartimento di Medicina Molecolare e Traslazionale, Università degli Studi di Brescia, Brescia, Italia
  1. Correspondence to Prof Alessandro Pezzini, Università degli Studi di Brescia, Brescia 25121, Italy; ale_pezzini{at}hotmail.com

Abstract

Objective To investigate the age-dependent impact of traditional stroke risk factors on the occurrence of intracerebral haemorrhage (ICH).

Methods We performed a case–control analysis, comparing consecutive patients with ICH with age-matched and sex-matched stroke-free controls, enrolled in the setting of the Multicenter Study on Cerebral Hemorrhage in Italy (MUCH-Italy) between 2002 and 2014 by multivariable logistic regression model within subgroups stratified by age quartiles (Q1–Q4).

Results We analysed 3492 patients and 3492 controls. The impact of untreated hypertension on the risk of ICH was higher in the lower than in the upper age quartile (OR 11.64, 95% CI 7.68 to 17.63 in Q1 vs OR 6.05, 95% CI 3.09 to 11.85 in Q4 with intermediate ORs in Q2 and Q3), while the opposite trend was observed for untreated hypercholesterolaemia (OR 0.63, 95% CI 0.45 to 0.97 in Q1 vs OR 0.36, 95% CI 0.26 to 0.56 in Q4 with intermediate ORs in Q2 and Q3). The effect of untreated diabetes and excessive alcohol intake was detected only in the older age group (OR 3.63, 95% CI 1.22 to 10.73, and OR 1.69, 95% CI 1.13 to 2.51, respectively).

Conclusions Our findings provide evidence of age-dependent differences in the effects of susceptibility factors on the risk of ICH.

  • cerebrovascular
  • stroke

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Footnotes

  • Contributors ML: study concept and design, acquisition of data, analysis of data, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and manuscript submission. MG: study concept and design, acquisition of data and interpretation of data. VS: study concept and design, acquisition of data, interpretation of data and statistical analysis. LI, ADC, GdG, MZ, SM, GS, AC, MLDL, LPC, AG, AZ, MP, MA, CA, ADV, MG, MM, MDS, AT, CG, CF, DMB, RT, GM, AC, AM, SB, VM, DP, AC, RSC, RM, PLS, FG, GT, CL, MR, MC: acquisition of data, critical revision of the manuscript for important intellectual content. APa: acquisition of data, critical revision of the manuscript for important intellectual content. APe: study concept and design, acquisition of data, analysis of data, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, administrative, technical, or material support, study supervision. AP had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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