title: Hypercholesterolemia, HMG-CoA reductase inhibitors, and risk of intracerebral hemorrhage: a case-control study.
abstract: OBJECTIVE
  Several studies have demonstrated an association between hypocholesterolemia and intracerebral hemorrhage (ICH). We tested the hypothesis that hypercholesterolemia or use of HMG-CoA reductase inhibitors (statin) agents, or both, are associated with ICH.
  
  
  METHODS
  This study was part of the preplanned midway analysis of an ongoing, population-based, case-control study of the genetic and environmental risk factors of hemorrhagic stroke. Conditional stepwise logistic regression modeling was used to determine if self-reported hypercholesterolemia or statin use, or both, were independent risk factors for ICH.
  
  
  RESULTS
  Between December 1, 1997, and June 30, 2000, 188 cases of ICH and 366 age-, race-, and gender-matched controls were enrolled. Hypercholesterolemia and statin use were less common among cases than controls: 25% versus 38% (P=0.003) and 9% versus 17% (P=0.03), respectively. Hypercholesterolemia with statin use was associated with less risk of ICH (OR=0.30; P=0.0008) in multivariable analysis after controlling for alcohol use, hypertension, previous stroke, first-degree relative with ICH, education level, and apolipoprotein E alleles.
  
  
  CONCLUSIONS
  Hypercholesterolemia was associated with a lower risk of ICH. We have not found an increased risk of ICH with the widespread use of statins in our population. Given the lack of cholesterol levels in the current study, further studies are needed to determine if lower cholesterol levels secondary to statin use bear the same risk as low cholesterol levels for ICH.
authors.affiliation: Department of Neurology and the Neuroscience Institute, University of Cincinnati, College of Medicine, 231 Bethesda Avenue ML 0525, Cincinnati, Ohio 45267-0525, USA. Daniel.woo@uc.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
authors.forename: Laura R
authors.initials: LR
authors.lastname: Sauerbeck
authors.forename: Mary A
authors.initials: MA
authors.lastname: Haverbusch
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.forename: James M
authors.initials: JM
authors.lastname: Gebel
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Pancioli
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.forename: Alexander
authors.initials: A
authors.lastname: Schneider
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D000368:Aged; D001057:Apolipoproteins E / Q000235:genetics; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D006937:Hypercholesterolemia / Q000150:complications*; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000150:complications
chemical_list: D001057:Apolipoproteins E; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors