Statin treatment and cerebral microbleeds: A systematic review and meta-analysis

Abstract

Although statins have been associated with increased risk of spontaneous intracerebral hemorrhage, their relationship with cerebral microbleeds (CMBs) formation is poorly understood. We systematically reviewed previously published studies reporting on the association between CMBs presence and current statin use.We performed a systematic search in MEDLINE and SCOPUS databases on October 24, 2019 to identify all cohorts from randomized-controlled clinical trials or observational studies reporting on CMB prevalence and statin use. We extracted cross-sectional data on CMBs presence, as provided by each study, in association to the history of current statin use. Random effects model was used to calculate the pooled estimates. We included 7 studies (n = 3734 participants): unselected general population [n = 1965], ischemic stroke [n = 849], hemorrhagic stroke [n = 252] and patients with hypertension over the age of 60 [n = 668]. Statin use was not associated with CMBs presence in either unadjusted (OR = 1.15, 95%CI: 0.76-1.74) or adjusted analyses (OR = 1.09, 95%CI: 0.64-1.86). Statin use was more strongly related to lobar CMB presence (OR = 2.01, 95%CI: 1.48-2.72) in unadjusted analysis. The effect size of this association was consistent, but no longer statistically significant in adjusted analysis that was confined to two eligible studies (OR = 2.26, 95%CI: 0.86-5.91). Except for the analysis on the unadjusted probability of lobar CMBs presence, considerable heterogeneity was present in all other analyses (I 2 > 60%). Our findings suggest that statin treatment seems not to be associated with CMBs overall, but may increase the risk of lobar CMB formation. This hypothesis deserves further investigation within magnetic resonance imaging ancillary studies of randomized trials.

Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

“…Statins could additionally mitigate the contribution of concurrent atherothrombotic vascular disease to the accrual of covert infarcts. A recent meta-analysis of mostly observational datasets reported an association between statin use and lobar cerebral microbleeds, 44 whereas another confined to randomized trials reported a reduction in the accrual of new covert infarcts with statin therapy. 45 The progression of white matter hyperintensities over time has been associated with increased risk of dementia and cognitive decline.…”

Beyond Lipid-Lowering: Effects of Statins on Cardiovascular and Cerebrovascular Diseases and Cancer

“…A large meta-analysis of 42 trials revealed no apparent association between statins and risk of ICH and showed a reduction in stroke and cerebral infarction [88]. Although several studies have been conducted on statin use and cerebral microbleeds (CMBs) formation, which are related to ICH, there is no clear association [89,90]. In addition, a large prospective cohort study suggested that statins might reduce the risk of ICH [91].…”

Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines

“…A recent meta-analysis examined the relationship between statin use and the development of CMBs. 23 It included seven studies (n=3,734 participants, with an unselected general population [n=1,965], patients with ischemic stroke [n=849], patients with hemorrhagic stroke [n=252], and patients with hypertension aged >60 years [n=668]). The results showed that statin use was not associated with CMBs in either unadjusted (OR, 1.15; 95% CI, 0.76 to 1.74) or adjusted analyses (OR, 1.09; 95% CI, 0.64 to 1.86).…”