Statin Use and Brain Hemorrhage

Gonzalez‐Castellon, Marco; Marshall, Randolph S.

doi:10.1001/jamaneurol.2014.2463

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…These results reflect an insufficient control of modifiable risk factors. Regarding the relationship between hypercholesterolemia, statin use and ICH risk, the available evidence indicates contradictory results in both primary and secondary prevention [29,30]. Heart failure has been identified as a comorbidity but not a protective factor [31].…”

Section: Discussionmentioning

confidence: 99%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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Background Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). Methods This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex. Results 161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127–174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88–6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11–2.35], and cardiovascular disease [OR 1.48 IC95% 1.05–2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89–0.97] and negative predictive value [0.98 (CI95% 0.83–1.12)]. Conclusions In the CCP subgroup the incidence density of ICH was 5–60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH. Trial registration This study was retrospectively registered in ClinicalTrials.gov (NCT03247049) on August 11/2017.

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Section: Discussionmentioning

confidence: 99%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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“…21 The increased risk of ICH with statin therapy has raised concerns regarding their use in ICH survivors given the potential devastating consequences of a recurrent ICH. [22][23][24][25][26] The SPARCL trial was the first secondary prevention randomized trial investigating the effect of statin treatment in a purely stroke population. 6 Participants, consisting of patients with recent stroke (noncardioembolic ischemic or ICH) or TIA within 6 months, were randomized to atorvastatin 80 mg or placebo.…”

Section: Hmg-co a Reductase Inhibitors (Statins)mentioning

confidence: 99%

“…Unsurprisingly, there exists considerable equipoise amongst stroke neurologists regarding the optimal strategy for management of dyslipidemia in ICH survivors with comorbid cardio/cerebrovascular disease indicating lipid-lowering treatments because of the competing risks of potential increased propensity for ICH versus prevention of subsequent ischemic cardiovascular events. [21][22][23][24][25] At an absolute annual event rate of 5% to 7% for the composite outcome of myocardial infarction and cardiovascular death in patients with significant coronary disease and a 25% RRR in this outcome with statin treatment, 65 the expected absolute risk reduction can be estimated to be 1.25% to 1.75% per year. In the context of secondary prevention of ischemic stroke, the absolute benefit of statin therapy is attenuated to ≈2% every 5 years.…”

Section: How Then To Approach the Management Of Hyperlipidemia In Pat...mentioning

confidence: 99%

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Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

Shoamanesh

Selim

2022

Stroke

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Hyperlipidemia is common in patients with intracerebral hemorrhage (ICH). Accumulating evidence indicates that patients with ICH are at risk for future hemorrhage recurrence, cardiovascular disease, and ischemic stroke and highlights the importance of secondary prevention of vascular events after ICH. Although the benefits of intensive treatment of hyperlipidemia for reducing ischemic cardiac and vascular events in patients with ischemic stroke are well established, the benefit versus harm in patients with ICH are less clear. Epidemiological studies suggest that hyperlipidemia is protective against ICH and that intensive lowering of lipids is associated with increased risk for ICH. Similarly, although currently available lipid-lowering treatments have been thoroughly studied in patients with ischemic cardiac and vascular disease, only few randomized trials of these therapies included a very small number of patients with history of ICH. Thus, limiting any definitive conclusions regarding the safety and net benefit of these treatments in ICH populations. Currently, there is no consensus regarding the optimal strategy for management of hyperlipidemia after ICH. In this article, we review relevant literature to outline the competing risks and benefits of lipid-lowering treatments in this vulnerable patient population. We suggest a treatment paradigm based on available data but note that data from dedicated randomized trials are needed to build the necessary evidence to guide optimal lipid-lowering strategy in patients with a history of ICH.

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Statins and Intracerebral Hemorrhage

Spence

2015

JAMA Neurol

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Statin Use and Brain Hemorrhage

Cited by 7 publications

References 13 publications

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

Statins and Intracerebral Hemorrhage

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