Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case-control study

We performed a case-control study to assess the relationship between primar y intracerebral hemorrhage (ICH) and low serum cholesterol. Prospectively r ecruited, fully evaluated patients with ICH were compared to two independen t control groups, one based in a primary care practice and one population-b ased. Low cholesterol was defined by the sex-specific lowest quintile of th e primary care controls. The proportion of ICH cases with low cholesterol > 3 months posthemorrhage was significantly greater than in controls (42 vs. 20% in either control group, p < 0.01). Subgroup analysis showed an overrep resentation of low cholesterols in probable hypertensive hemorrhage (47%, p < 0.05) but not in probable cerebral amyloid angiopathy (27%, p = 0.5). Lo w cholesterol increased the odds for hemorrhage 2.25-fold (1.12-4.50) after adjustment for age and apolipoprotein E genotype. These data confirm an in creased risk for primary ICH associated with low cholesterol, a relationshi p that may apply specifically to hemorrhages from hypertensive vasculopathy .