Statins and the Risk of Intracerebral Hemorrhage in Patients With Previous Ischemic Stroke or Transient Ischemic Attack

• Published in: Stroke (1970) Vol. 48; no. 12; pp. 3245 - 3251
• Main Authors: Gaist, David, Goldstein, Larry B, Cea Soriano, Lucía, García Rodríguez, Luis Alberto
• Format: Journal Article
• Language: English
• Published: United States 01.12.2017
• Subjects: Adult; Aged; Aged, 80 and over; Brain Ischemia - complications; Brain Ischemia - epidemiology; Case-Control Studies; Cerebral Hemorrhage - epidemiology; Cohort Studies; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Incidence; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - epidemiology; Male; Middle Aged; Risk Assessment; Risk Factors; Socioeconomic Factors; Stroke - complications; Stroke - epidemiology; United Kingdom - epidemiology; hydroxymethylglutaryl-CoA reductase inhibitors; primary health care; ischemic attack, transient; cerebral hemorrhage; statin; stroke
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.117.019141

Although there is no overall association between statin use and intracerebral hemorrhage (ICH), whether there is an increased risk among those with a history of ischemic stroke (IS) or transient ischemic attack (TIA) remains controversial. We evaluated the relationship of preadmission statin use with the risk of ICH in patients with a history of IS or TIA in a population-based cohort. The Health Improvement Network primary care database in the United Kingdom was used to identify new users of low-dose aspirin and a matched comparison. Both cohorts were followed to identify incident cases of ICH, with validation by manual review of patient records and linkage to hospitalization data. In a nested case-control study, we compared the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for ICH based on statin use in the subgroup of individuals with history of IS/TIA. Last statin use within 1 year of ICH (OR, 0.92; 95% CI [confidence interval], 0.60-1.4), last use between 8 days and 1 year (OR, 1.81; 95% CI, 0.99-3.28), and statin use at the time of ICH (OR, 0.77; 95% CI, 0.49-1.21) were not associated with the overall ICH risk among 157 patients with ICH and 884 controls with a history of IS/TIA. There was also no difference in 30-day rates of fatal (OR, 0.82; 95% CI, 0.41-1.64) or nonfatal (OR, 0.90; 95% CI, 0.51-1.57) ICH. Statin use was not associated with an increased risk of ICH among patients with a previous history of IS/TIA.