Abstract
Spontaneous intracerebral hemorrhage (ICH) often represents a devastating event despite maximal therapeutic efforts. Statins are drugs primarily used as cholesterol reducers with several pleiotropic effects that may result in neuroprotection. In this study, we assessed the continued use of statins after acute ICH. From January 2008 to October 2010, we analyzed a retrospective cohort of 178 patients with acute ICH. Patients with head injury, cerebral tumors, hemorrhage after ischemic stroke, and having a National Institute Health Stroke Scale (NIHSS) score of greater than 30 points on admission were excluded. In 29 patients, statins were continued within the first 24 h after onset of ICH and, subsequently, given daily until discharge, whereas 149 nonusers were used as controls. Inpatient mortality, NIHSS, and Glasgow Outcome Score (GOS) at discharge as well as mortality after 10 days, 3 months, and 6 months were recorded as outcomes. Additionally, changes of C-reactive protein (CRP) and white blood cell (WBC) counts, as well as aspartate transaminase and alanine transaminase levels were assessed. Except for the number of hypertensive and diabetic patients, characteristics on admission were similar between both groups. No mortality was observed in statin users, whereas 19 controls (12.7 %) died (p = 0.04) until discharge; after 10 days, 3 months, and 6 months, a similar trend was found. After 6 months, statin use was associated to lower mortality in regression models (OR = 0.32, 95 % CI = 0.11–0.95, p = 0.04). In the same way, statin use was related to NIHSS reduction (−3.53, 95 % CI = −7.59 to 0.42, p = 0.07). In mixed models, changes of WBC counts and CRP levels were associated with statin use. The hepatic enzymes were similar between groups. The continued use of statins after ICH could be associated to early neurological improvement and may reduce mortality within 6 months. Immunomodulation as a pleiotropic effect of statins may represent one of the underlying mechanisms.
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We thank Prof. Kropf, Institut für Biometrie und Medizinische Informatik, Otto-von-Guericke-Universität, Magdeburg, Germany for his suggestions regarding the statistical analysis.
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Rüdiger Gerlach, Erfurt, Germany
Based on a retrospective cohort study including 178 patients (29 with antecedent use of statins prior to intracranial hemorrhage (ICH) and 149 controls), the authors found a positive effect of statins on patient’s outcome after ICH. Booth groups were compared with emphasis of immunomodulatory effects of statins, while assessing CRP and WBC.
The results are in line with a recent larger prospectively ascertained cohort [3] and show a beneficial effect of statins on patients with ICH. Patient’s characteristics, hematoma size, and location did not differ between groups, while hypertension and diabetes mellitus were more common in the group of patients with statin treatment.
Although there is only limited new information compared to the recently published series, the authors did a thorough statistical work up of the patients data and it was shown that the statin use was not associated with adverse effects and hepatotoxicity.
The shortcomings of the study were adequately discussed, and so the authors point out that prospective data collection with one pharmacologic compound must be the next step to proof the described findings.
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Tapia-Pérez, J.H., Rupa, R., Zilke, R. et al. Continued statin therapy could improve the outcome after spontaneous intracerebral hemorrhage. Neurosurg Rev 36, 279–287 (2013). https://doi.org/10.1007/s10143-012-0431-0
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DOI: https://doi.org/10.1007/s10143-012-0431-0