title: Association between alanine aminotransferase and intracerebral hemorrhage in East Asian populations.
abstract: BACKGROUND
  Intracerebral hemorrhage (ICH) and chronic liver disease are relatively common in East Asian countries. However, the relationship between the two diseases is unclear. Thus, we investigated the association between serum alanine aminotransferase (ALT) levels and ICH risk in East Asian populations.
  
  
  METHODS
  The East Asian Network for Stroke Prevention enrolled 279,982 participants with ALT measurements from four cohort studies in Korea, Taiwan, Japan and mainland China. Among them, 1,324 ICH events and 493 ICH deaths were observed. Cox's proportional hazard regression analysis was performed in each cohort to estimate the hazard ratio (HR) after adjusting for age, blood pressure, diabetes, total cholesterol, smoking and alcohol intake. Combined HRs were then estimated using pooled analyses with fixed-effects models.
  
  
  RESULTS
  The multivariate-adjusted pooled HRs (with 95% confidence interval, CI) for ICH incidence per 10 IU/l increments of ALT were 1.04 (1.03-1.04) in men and 1.01 (0.98-1.04) in women. Corresponding HRs for ICH mortality were 1.04 (1.02-1.05) in men and 1.04 (1.00-1.08) in women. The pooled HRs for ICH incidence in participants with ALT levels greater than or equal to 50 IU/l compared to those with levels less than 20 IU/l were 1.74 (1.41-2.16) in men and 1.60 (1.06-2.40) in women. The corresponding HRs for ICH mortality were 1.72 (1.21-2.44) in men and 1.63 (0.79-3.36) in women.
  
  
  CONCLUSIONS
  An elevated ALT level was independently and significantly associated with an increased risk of ICH in East Asian men, but the association was less prominent in women.
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyeon Chang
authors.initials: HC
authors.lastname: Kim
authors.forename: Sun Min
authors.initials: SM
authors.lastname: Oh
authors.forename: Wen-Harn
authors.initials: WH
authors.lastname: Pan
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Gu
authors.forename: Shao-Yuan
authors.initials: SY
authors.lastname: Chuang
authors.forename: Akira
authors.initials: A
authors.lastname: Fujiyoshi
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: Liancheng
authors.initials: L
authors.lastname: Zhao
authors.forename: Il
authors.initials: I
authors.lastname: Suh
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D044466:Asian People / Q000208:ethnology*; D015415:Biomarkers / Q000097:blood; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology*; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D005202:Asia, Eastern / Q000208:ethnology; D005260:Female; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000208:ethnology; D012737:Sex Factors; D013624:Taiwan / Q000208:ethnology
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase