Statin use after intracerebral hemorrhage: a 10‐year nationwide cohort study

Abstract

IntroductionAlthough statin therapy is beneficial to patients with ischemic stroke, statin use, and intracerebral hemorrhage (ICH) remain a concern. ICH survivors commonly have comorbid cardiovascular risk factors that would otherwise warrant cholesterol‐lowering medication, thus emphasizing the importance of assessing the characteristics of statin therapy in this population.MethodsWe performed a cohort study by using 10 years of data collected from the National Health Insurance Research Database in Taiwan. We enrolled 726 patients admitted for newly diagnosed ICH from January 1, 2001 to December 31, 2010. The patients were categorized into high‐ (92), moderate‐ (545), and low‐intensity (89) statin groups, and into hydrophilic (295) and lipophilic (431) statin groups. The composite outcomes included all‐cause mortality, recurrent ICH, ischemic stroke, transient ischemic attack, and acute coronary events.ResultsThe patients in the low‐intensity group did not differ significantly from the patients in the high‐intensity group in risk of all‐cause mortality (adjusted hazard ratio [aHR] = 0.65, 95% confidence interval [CI] = 0.28–1.55) and recurrent ICH (aHR = 0.66, 95% CI = 0.30–1.44). In contrast, the patients in the hydrophilic group had a significantly lower risk of recurrent ICH than did those in the lipophilic group (aHR = 0.69, 95% CI = 0.48–0.99). We determined no significant differences in other composite endpoints between hydrophilic and lipophilic statin use.ConclusionHydrophilic statin therapy is associated with a reduced risk of recurrent ICH in post‐ICH patients. The intensity of statin use had no significant effect on recurrent ICH or other components of the composite outcome. Additional studies are required to clarify the biological mechanisms underlying these observations.

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

“…606,612 However, other observational, nonrandomized studies have not found this association in patients with hypercholesterolemia, and risk may depend on the patient risk for recurrent ICH and type of statin used. 607,609,613–618 For both classes of medications, the indications and risk-benefit profiles for an individual patient must be weighed. NSAID use is associated with an increased risk of bleeding 610,611 ; thus, regular long-term use should be avoided when possible in patients with ICH.…”

Intracerebral hemorrhage: an update on diagnosis and treatment

“…The "Stroke Prevention by Aggressive Reduction in Cholesterol Levels" (SPARCL) trial initially raised concern that statins might increase the risk for future ICH among patients with previous ischemic stroke or ICH [160]. While some studies also suggested an increased recurrent ICH risk in ICH survivors using statins [160][161][162][163], others suggest that statins used acutely are associated with improved mortality and functional outcome [164,165]. A recent meta-analysis of statin use in stroke survivors found no evidence that statin use in ICH survivors increases future ICH; there was a small increased risk of ICH after ischemic stroke; however, the strongest finding was that in all stroke survivors (ischemic stroke or ICH) there was a substantial and significant improvements in mortality and functional outcomes among statin users [166].…”

Drug Utilization Study of Statin in Hemorrhagic Stroke

“…Additionally, the intensity of statin use had no significant relationship with recurrent ICH or other secondary adverse outcomes. Additional prospective randomized clinical trials are required to confirm the favorable effects of hydrophilic statin therapy in ICH patients (Tai, Lin & Lee et al 2016). According to study in animal, simvastatin and atorvastatin treatment for 1 week after ICH significantly improved neurological outcome and reduced hematoma volume and tissue loss at 4 weeks.…”