Sir,
We agree with the authors that, the risk (low cholesterol) was not identified before the event (intra-cerebral hemorrhage) onset in our study. Potential source of error in our study is the use of lipid values within 48 hours of the ICH as estimates of the pre-hemorrhage levels. We had already admitted this limitation in our paper. Segal AZ et al,[1] in a better study design, taking serum cholesterol level at 3 months after ICH as an estimate of pre ICH cholesterol level also found the inverse association between low cholesterol and risk of ICH. The association of pre ICH cholesterol level and risk of ICH was studied by K Yano et al,[2] as a part of Honolulu heart program and inverse association between serum cholesterol and risk of ICH was found. We agree that proper assessment of risks and benefits of low cholesterol level will only be established by a large cohort study.
References
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