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Statin use and long-term risk of recurrent intracerebral haemorrhage: the MUCH-Italy
  1. Alessandro Pezzini1,2,
  2. Barbara Tarantino3,
  3. Maria Luisa Zedde4,
  4. Simona Marcheselli5,
  5. Giorgio Silvestrelli6,
  6. Alfonso Ciccone6,
  7. Maria Luisa Delodovici7,
  8. Lucia Princiotta Cariddi7,
  9. Simone Vidale7,
  10. Maurizio Paciaroni8,
  11. Cristiano Azzini9,
  12. Marina Padroni9,
  13. Massimo Gamba10,
  14. Mauro Magoni10,
  15. Massimo Del Sette11,
  16. Rossana Tassi12,
  17. Ivo Giuseppe de Franco12,
  18. Anna Cavallini13,
  19. Rocco Salvatore Calabrò14,
  20. Manuel Cappellari15,
  21. Elisa Giorli16,
  22. Giacomo Giacalone17,
  23. Corrado Lodigiani18,
  24. Mara Zenorini19,
  25. Francesco Valletta19,
  26. Rosario Pascarella20,
  27. Giorgia Abrignani2,
  28. Paola Castellini2,
  29. Antonio Genovese2,
  30. Lilia Latte2,
  31. Maria Claudia Trapasso2,
  32. Ilaria Grisendi4,
  33. Federica Assenza4,
  34. Manuela Napoli20,
  35. Claudio Moratti20,
  36. Sofia Beccattini8,
  37. Maurizio Acampa12,
  38. Franco Valzania4,
  39. Mario Grassi3,
  40. Davide Gentilini3
  41. Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) Investigators
  1. 1Department of Medicine and Surgery, University of Parma, Parma, Italy
  2. 2Stroke Care Program, Department of Emergencies, Parma University Hospital, Parma, Italy
  3. 3Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italy
  4. 4S.C. Neurologia, S.C. Neurologia, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
  5. 5Neurologia D'urgenza e Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy
  6. 6Stroke Unit, Dipartimento di Neuroscienze, ASST Mantova, Mantova, Italy
  7. 7Unità di Neurologia, Unità di Neurologia, Ospedale di Circolo, Università dell’Insubria, Varese, Italy
  8. 8Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italy
  9. 9Stroke Unit, Divisione di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
  10. 10Stroke Unit, Neurologia Vascolare, ASST Spedali Civili di Brescia, Brescia, Italy
  11. 11Struttura Complessa di Neurologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  12. 12Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
  13. 13UOC Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale “C. Mondino,”, Pavia, Italy
  14. 14Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italy
  15. 15Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  16. 16U.O. Neurologia, Ospedale S. Andrea, La Spezia, Italy
  17. 17Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italy
  18. 18UOC Centro Trombosi, IRCCS Humanitas, Rozzano-Milano, Italy
  19. 19Azienda Ospedaliera Universitaria Integrata Verona Sede di Borgo Trento, Verona, Italy
  20. 20SSD Neuroradiologia, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
  1. Correspondence to Professor Alessandro Pezzini, Department of Medicine and Surgery, University of Parma and Stroke Care Program, Department of Emergencies, Parma University Hospital, Parma, Italy; alessandro.pezzini{at}


Background Whether statin use after spontaneous intracerebral haemorrhage (ICH) increases the risk of recurrent ICH is uncertain.

Methods In the setting of the Multicentric Study on Cerebral Haemorrhage in Italy we followed up a cohort of 30-day ICH survivors, consecutively admitted from January 2002 to July 2014, to assess whether the use of statins after the acute event is associated with recurrent cerebral bleeding.

Results 1623 patients (mean age, 73.9±10.3 years; males, 55.9%) qualified for the analysis. After a median follow-up of 40.5 months (25th to 75th percentile, 67.7) statin use was not associated with increased risk of recurrent ICH either in the whole study group (adjusted HR, 0.99; 95% CI 0.64 to 1.53) or in the subgroups defined by haematoma location (deep ICH, adjusted HR, 0.74; 95% CI 0.35 to 1.57; lobar ICH, adjusted HR, 1.09; 95% CI 0.62 to 1.90), intensity of statins (low-moderate intensity statins, adjusted HR, 0.93; 95% CI 0.58 to 1.49; high-intensity statins, adjusted HR, 1.48; 95% CI 0.66 to 3.31) and use of statins before the index event (adjusted HR, 0.66; 95% CI 0.38 to 1.17).

Conclusions Statin use appears to be unrelated to the risk of ICH recurrence.


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  • Contributors AP had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: AP, MG. Acquisition of data: all authors. Interpretation of data: AP, MG. Drafting of the manuscript: AP. Critical revision of the manuscript for important intellectual content: all authors. Data analysis: AP, MG. Statistical analysis: AP, MG. Administrative, technical or material support: AP. Study supervision: AP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AC reports grants from Daiichi-Sankyo; grants from Italfarmaco; and grants from Alexion Pharmaceuticals. MP reports compensation from SANOFI-AVENTIS US LLC for other services; compensation from PFIZER CANADA for other services; compensation from iRhythm Technologies for other services; compensation from Daiichi Sankyo Europe GmbH for other services; and compensation from Bristol-Myers Squibb for other services. The other authors have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.