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Statins and Intracerebral Hemorrhage: A Retrospective Cohort Study
Study Questions:
What is the association between statins and intracerebral hemorrhage (ICH) in patients with recent ischemic stroke in a population-based setting?
Methods:
This was a retrospective propensity-matched cohort study with accrual from July 1, 1994 to March 31, 2008, in Ontario, Canada. A total of 17,872 patients ages 66 years and older who initiated statin therapy following acute ischemic stroke were followed for a median of 4.2 years (interquartile range, 2.4-5.0 years). To enhance causal inference, the authors conducted several tests of specificity to exclude healthy user bias in this sample. Main outcome measures were hospitalization or emergency department visit for ICH defined using validated diagnosis coding.
Results:
Overall, 213 episodes of ICH occurred. In the primary analysis comparing statin users with nonusers, authors found no association between statins and ICH (hazard ratio, 0.87; 95% confidence interval, 0.65-1.17). Subgroup and dose-response analyses yielded similar results. In tests of specificity, statin therapy was not associated with bone mineral density testing, vitamin D or B12 screening, gastrointestinal endoscopy, or elective knee arthroplasty, suggesting that results were not due to healthy user bias or differences in quality of care.
Conclusions:
The authors concluded that statin exposure following ischemic stroke was not associated with ICH.
Perspective:
This study found no association between statins and subsequent ICH. This lack of harmful association was maintained across subgroup analyses, and irrespective of statin dosing. Based on these data and the meta-analysis of statin trials from the Cholesterol Treatment Trialists’ Collaboration, clinicians should continue to adhere to current national treatment guidelines recommending statin therapy for most patients with a history of ischemic stroke.
Keywords: Incidence, Cardiology, Canada, Cardiovascular Diseases, Endoscopy, Ontario, Vitamin D, Cerebral Hemorrhage
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