Increased incidence of cerebral hemorrhage in the elderly, study finds

The incidence of brain hemorrhages, called intracerebral hemorrhages, has remained stable in all age groups over the past 30 years, but has increased in people 75 and older, according to a new analysis of the Framingham Cardiology study. The findings are available in JAMA Neurology.

Anticoagulant use in older adults also tripled during this period, but the authors cautioned against using too much.

“We are not advocating that people stop taking statins or anticoagulants. These treatments reduce the risk of ischemic stroke, which represents about nine out of every 10 strokes, while intracerebral hemorrhage occurs in one.”

Dr. Sudha Seshadri, neurologist at the Long School of Medicine at the University of Texas Health Science Center in San Antonio

D., senior investigator at the Framingham Study of Cardiology and UT Health San Antonio. Seshadri said the healthcare system will likely see an increase in the number of patients with cerebral hemorrhages due to the increase in life expectancy and the aging of the population.

Imaging and medications

D., a stroke neurologist at Beth Israel Deaconess Medical Center and Harvard Medical School, the report's lead author. Vasileios-Arsenios Lioutas project created the study to evaluate trends in the incidence of intracerebral hemorrhage in 10,333 Framingham participants from 1948 to 2016. During the study follow-up, 129 experienced bleeding in this area.

He divided the years into three periods: 1948-1986, 1987-1999 and 2000-2016.

Dr. "We wanted to account for changes in diagnostic approaches, and one of the main advances was CT scanning, which was introduced around 1980," Lioutas said. said. "Many things that weren't previously diagnosed as bleeding could be seen very easily after that."

The late 1990s saw an increase in the prescription of blood thinners such as warfarin, which, after a series of trials, has been shown to be effective at preventing clots from atrial fibrillation, a heart rhythm abnormality. In the 2000s, more preventive practices and additional drugs were added.

Dr. "One possible explanation for why we're seeing more bleeding in older Framingham participants is that by using these anticoagulants we prevented adverse events that could potentially kill them early in life," said Lioutas. "We extended their lifespan and then, because we did that, they risked bleeding later in life."

Dr. "It's a bit of a balancing act," Seshadri said. said. "We want to be careful what message we send about this. Statins and anticoagulants have value in preventing life-changing or fatal events."

The role of hypertension

The study also looked at risk factors for two types of cerebral hemorrhage. Lobar intracerebral hemorrhages occur closer to the surface of the brain, while deep intracerebral hemorrhages occur deeper within the brain substance and involve different structures.

In the study, hypertension, previously thought to be more important as a risk factor for deep intracerebral hemorrhages, increased the risk in both types.

Dr. Lioutas said that deep intracerebral hemorrhages are associated with changes in very small vessels of the brain as a result of prolonged exposure to hypertension.

Lobar hemorrhages also show changes in the small vessels, but the vessels are close to the surface of the brain. Amyloid protein deposits, most known to be associated with Alzheimer's disease, are believed to be the culprit in these hemorrhages.

Dr. "As with previous research, we found that these dividing lines were not very clear," said Lioutas. "We found that many people also have hypertension, especially in lobar hemorrhage, so we now believe that hypertension plays a role in both deep and lobar intracerebral hemorrhages."

The study shows that although clinical advances have been successful in reducing stroke rates in developed countries, the decline is mostly in clot-related strokes, not hemorrhagic strokes.

Dr. "We've seen an increase in intracerebral hemorrhages in the elderly Framingham population, in a demographic group that has grown from year to year in the United States and worldwide," said Seshadri. "We have to find new ways to prevent these strokes, and at the same time, the healthcare system should be prepared to treat more bleeding in the future."

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