Perspective:

The search for a ‘free lunch’ sometimes seems to be a never-ending human endeavor. The magnitude of the benefit seen from the use of statins is so great, that any finding of slightly increased risk of adverse events—however severe—should not dissuade anyone from their use. Furthermore, if randomized trials demonstrate a dramatic reduction in lives lost and strokes suffered (which clearly takes into account any intracerebral hemorrhages attributable to the medication), then the benefit is clear, and the use of the medication should be strongly recommended. An obsessive search for evidence of increased risk of adverse events associated with the use of statins therefore misses the point, does not inform clinical decision-making, and runs the very significant risk of decreasing adherence to these effective preventive therapies. Even if an increased risk of intracerebral hemorrhage was associated with statin use, the idea that this could be clinically useful information, or support the avoidance of these agents in patients perceived to be at increased risk for intracerebral hemorrhage, would remain highly speculative. Fortunately, this exhaustive, well-performed, and comprehensive study establishes that there is either no association between statin use and intracerebral hemorrhage, or the risk is so small as to be so far undetectable.