Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 31;101(18):e1793-e1806.
doi: 10.1212/WNL.0000000000207792. Epub 2023 Aug 30.

Association of Statin Use With Risk of Stroke Recurrence After Intracerebral Hemorrhage

David Gaist  1 , Luis Alberto García Rodríguez  2 , Jesper Hallas  2 , Stine Munk Hald  2 , Sören Möller  2 , Birgit Bjerre Høyer  2 , Magdy Selim  2 , Larry B Goldstein  2
Affiliations

Association of Statin Use With Risk of Stroke Recurrence After Intracerebral Hemorrhage

David Gaist et al. Neurology. .

Abstract

Background and objectives: Survivors of spontaneous intracerebral hemorrhage (ICH) may have indications for statin therapy. The effect of statins on the risk of subsequent hemorrhagic and ischemic stroke (IS) in this setting is uncertain. We sought to determine the risk of any stroke (ischemic stroke, IS or recurrent ICH), IS, and recurrent ICH associated with statin use among ICH survivors.

Methods: Using the Danish Stroke Registry, we identified all patients admitted to a hospital in Denmark (population 5.8 million) with a first-ever ICH between January 2003 and December 2021 who were aged 50 years or older and survived >30 days. Patients were followed up until August 2022. Within this cohort, we conducted 3 nested case-control analyses for any stroke, IS, and recurrent ICH. We matched controls for age, sex, time since first-ever ICH, and history of prior IS. The primary exposure was statin use before or on the date of subsequent stroke or the equivalent date in matched controls. Using conditional logistic regression, we calculated adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) for any stroke, IS, and recurrent ICH associated with statin exposure.

Results: We identified 1,959 patients with any stroke (women 45.3%; mean [SD] age, 72.6 [9.7] years) who were matched to 7,400 controls; 1,073 patients with IS (women 42.0%; mean [SD] age, 72.4 [10.0] years) who were matched to 4,035 controls and 984 patients with recurrent ICH (women 48.7%; mean [SD] age, 72.7 [9.2] years) who were matched to 3,755 controls. Statin exposure was associated with a lower risk of both any stroke (cases 38.6%, controls 41.1%; aOR 0.88; 95% CI 0.78-0.99) and IS (cases 39.8%, controls 41.8%, aOR 0.79; 95% CI 0.67-0.92), but was not associated with recurrent ICH risk (cases 39.1%, controls 40.8%, aOR 1.05; 95% CI 0.88-1.24).

Discussion: Exposure to statins was not associated with an increased risk of recurrent ICH but was associated with a lower risk of any stroke, largely due to a lower risk of IS. Confirmation of these findings in randomized trials is needed.

Classification of evidence: This study provides Class III evidence that statin use in patients with ICH is associated with a lower risk of any stroke and IS and not with increased risk of recurrent ICH.

PubMed Disclaimer

Conflict of interest statement

D. Gaist received speaker honoraria from Bristol-Myers Squibb and Pfizer outside the submitted work; L.A. García Rodríguez reports no disclosures relevant to the manuscript; J. Hallas has participated in postauthorization safety studies funded by Pfizer, Menarini, Leo Pharma, and Novo Nordisk, with money paid to his employer and with no personal fees; S.M. Hald reports no disclosures relevant to the manuscript; S. Möller reports no disclosures relevant to the manuscript; B.B. Høyer reports no disclosures relevant to the manuscript; M. Selim receives support from the NIH (NINDS; U01NS102289, and NIA; UF1NS120871) and serves as the Principal Investigator for the SATURN trial, he serves as a consultant/Advisory Board member for MedRhythms Inc. and MexBrain; L.B. Goldstein reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Figures

Figure
Figure
Study flow-chart.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Amarenco P, Bogousslavsky J, Callahan A, et al. . High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549-559. doi:10.1056/nejmoa061894 - DOI - PubMed
    1. Goldstein LB, Amarenco P, Szarek M, et al. . Hemorrhagic stroke in the stroke prevention by aggressive reduction in cholesterol levels study. Neurology 2008;70(24 Pt 2):2364-2370. doi:10.1212/01.wnl.0000296277.63350.77 - DOI - PubMed
    1. Westover MB, Bianchi MT, Eckman MH, Greenberg SM. Statin use following intracerebral hemorrhage: a decision analysis. Arch Neurol. 2011;68(5):573-579. doi:10.1001/archneurol.2010.356 - DOI - PMC - PubMed
    1. Chen PS, Cheng CL, Chang YC, Kao Yang YH, Yeh PS, Li YH. Early statin therapy in patients with acute intracerebral hemorrhage without prior statin use. Eur J Neurol. 2015;22(5):773-780. doi:10.1111/ene.12649 - DOI - PubMed
    1. Schmidt LB, Goertz S, Wohlfahrt J, Melbye M, Munch TN. Recurrent intracerebral hemorrhage: associations with comorbidities and medicine with antithrombotic effects. PLoS One. 2016;11:e0166223. doi:10.1371/journal.pone.0166223 - DOI - PMC - PubMed

Publication types

Substances