Doubt cast on statin-associated ICH risk in stroke patients
MedWire News: Findings from a large observational study contradict the belief that statin use may raise the risk for intracerebral hemorrhage (ICH) in patients with previous ischemic stroke.
"Physicians should continue to adhere to current treatment guidelines recommending statin therapy for most patients with a history of ischemic stroke," say Daniel Hackam (University of Western Ontario, London, Canada) and co-workers.
The study included data on 17,872 patients, aged at least 66 years, drawn from US and Canadian healthcare databases. None of the patients had used statins in the year before being hospitalized for acute ischemic stroke, and all survived to at least 120 days from discharge. The cohort consisted of 8936 patients who were prescribed a statin within 120 days of hospital discharge, who were matched for the propensity to receive a statin to a further 8936 controls who were not prescribed a statin.
Over a median 4.2 years of follow-up, 213 patients had an ICH, the team reports in the Archives of Neurology. The ICH rate was slightly, but not significantly, lower in the statin than nonstatin group, at 2.94 and 3.71 per 1000 patient years, respectively - a nonsignificant 13% relative reduction.
This finding did not differ within prespecified subgroups, or when considering high versus low statin doses. But on excluding patients who crossed over between the propensity-matched groups (ie, nonadherent statin users and nonusers who subsequently started on statin therapy), statin users had a significantly lower risk for ICH than nonusers - a 35% reduction.
However, the researchers note that a recent Markov decision analysis revealed a possible increased risk for recurrence among statin-treated patients with previous lobar ICH.
"Given the findings of the decision analysis and the high risk of recurrence of ICH, caution must be applied when considering statins in such patients," they say.
In an accompanying editorial, Philip Gorelick (University of Illinois College of Medicine, Chicago, USA) said that the findings go against those from post-hoc analyses of two major clinical trials, and of the decision analysis. He suggested that the different limitations of the various types of study may have contributed to the contradictory conclusions.
"Until we have additional, high-level evidence to clarify the statin-ICH risk relationship, I recommend careful control of modifiable risks for brain hemorrhage, such as blood pressure, in those who are treated with a statin," he said.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid