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Statins and the risk of intracerebral haemorrhage in patients with stroke: systematic review and meta-analysis
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  • Published on:
    Snack Shacks, Statin Islands, and Brain Bleeds
    • George K Vilanilam, Clinical Neurology Fellow Mayo Clinic, FL, USA
    • Other Contributors:
      • Aiswarya L Nandakumar, Neurology Research Fellow
      • Mohammed K Badi, Research Trainee

    The interplay among statins, serum cholesterol, and spontaneous intracerebral hemorrhage (ICH) with and without prior history of ischemic stroke is controversial.

    Studies over the last decade, like the GERFHS study,[1] have concluded that increasing serum cholesterol levels may decrease the risk of ICH. This finding was confirmed in one of the largest observational studies[2] which estimated an adjusted hazard ratio (HR) of 0.94 (0.92-0.96) with every 10 mg increase in baseline serum total cholesterol level. Similar interaction was observed with increasing LDL cholesterol quartiles (LDL > 168 mg/dL; HR 0.53 [0.45-0.63]).[2]

    However, the evidence on the effect of statins in ICH is less clear. Studies ranging from the SPARCL trial[3] which showed an increased risk of recurrent ICH with high dose statins to the recent meta-analysis by Ziff et al.,[4] which described no significant increase of the risk of ICH with statins, are few examples. Similar non-significant trends were seen in the risk of ICH after prior ischemic stroke and prior ICH.[3] Prior retrospective studies also described a neutral effect of statins on recurrent ICH. Interestingly, analysis from the largest administrative database in Israel[2] showed a surprising result; statin use might be associated with decreased ICH risk. Furthermore, an indirect, albeit unique measurement of dose-response using average atorvastatin equivalent daily dose (AAEDD) churned out interesting figures – a HR of 0....

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    Conflict of Interest:
    None declared.