Statin use and outcome after intracerebral hemorrhage

Abstract

Objectives: Intracerebral hemorrhage (ICH) is a highly lethal disease of the elderly. Use of statins is increasingly widespread among the elderly, and therefore common in patients who develop ICH. Accumulating data suggests that statins have neuroprotective effects, but their association with ICH outcome has been inconsistent. We therefore performed a meta-analysis of all available evidence, including unpublished data from our own institution, to determine whether statin exposure is protective for patients who develop ICH. Methods:In our prospectively ascertained cohort, we compared 90-day functional outcome in 238 pre-ICH statin cases and 461 statin-free ICH cases. We then meta-analyzed results from our cohort along with previously published studies using a random effects model, for a total of 698 ICH statin cases and 1,823 non-statin-exposed subjects. Conclusion: Antecedent use of statins prior to ICH is associated with favorable outcome and reduced mortality after ICH. This phenomenon appears to be a class effect of statins. Further studies are required to clarify the biological mechanisms underlying these observations. Results Neurology® 2011;76:1581-1588 GLOSSARY CI ϭ confidence interval; GCS ϭ Glasgow Coma Scale score; ICH ϭ intracerebral hemorrhage; LDL ϭ low-density lipoprotein; MGH ϭ Massachusetts General Hospital; mRS ϭ modified Rankin Scale; OR ϭ odds ratio.Intracerebral hemorrhage (ICH) accounts for 15% of all acute strokes, with societal and public health ramifications largely determined by the associated prognosis. 1 Despite substantial advances in the field of neurocritical care, more than half of patients with ICH face the prospect of death or severe disability.2 New research directions are therefore crucially needed in order to understand the complex pathophysiology of ICH outcome and recovery and exploit this understanding to benefit patients. 3Several studies investigating animal models of ICH suggest that statins exert a beneficial effect on functional recovery. [4][5][6] These findings could be explained by the effect of statins on lipid metabolism, or by other effects including neuroprotection and stimulation of neurogenesis and synaptogenesis. 7,8 Evidence from observational studies in patients, however, is conflicting, with some groups

Association of Prestroke Statin Use and Lipid Levels With Outcome of Intracerebral Hemorrhage

“…[2][3][4] Other studies have, on the contrary, found statins to be associated with reduced disability and mortality after ICH. 5,6 Also low serum cholesterol, 7 low-density lipoprotein (LDL) cholesterol, [7][8][9][10] and triglyceride levels 7 were associated with an increased risk of ICH and ICH mortality, although not in all studies. 4 Because of these controversial results, we decided to study the associations of premorbid statin usage and baseline lipid profiles on the functional outcome and mortality in consecutive ICH patients.…”

Antioxidant Strategies in Neurocritical Care

“…The ongoing phase III Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) multi-center randomized controlled phase III trial should help to further clarify the role of statins in these patients. Retrospective studies suggest that antecedent use of statins is associated with improved outcome and reduced mortality in patients with acute ischemic stroke and ICH [104,105]. Future studies examining the role of statins as an acute treatment in PHE reduction in ICH and resultant effect on mortality and functional outcome after ischemic and hemorrhagic stroke are warranted.…”

Serum Lipids and Statin Treatment During Acute Stroke

“…The patients under statin treatment had a better baseline neurological status or better outcome and a lower mortality rate [Leker et al, 2009]. In a prospective ascertained cohort study, Biffi et al [2011] compared 238 statin pretreated intracerebral hemorrhage patients with 461 non treated patients. They extended their own results into a meta analysis of previously published data -for a total of 698 vs 1,823 patients.…”