Statins tied to lower risk for brain hemorrhage in stroke-free patients

  • EClinicalMedicine

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Individuals with no history of stroke who initiated statins had a lower risk for intracerebral hemorrhage (ICH) that became significant after 6 months of use.

Why this matters

  • Potential withholding of statins because of unclear risk-benefit profile.

Key results

  • ICH incidence: 0.25% among statin users vs 0.30% among nonusers.
  • Relative to nonusers, users had 15% lower ICH risk overall (aHR, 0.85; 95% CI, 0.80-0.90).
  • Risk varied by time since statin initiation; significant difference emerged at 6 months, with reductions thereafter of 22%-35%:
    • 6 months-1 year: aHR, 0.65 (95% CI, 0.55-0.78).
    • 1-2 years: aHR, 0.78 (95% CI, 0.69-0.90).
    • 2-10 years: aHR, 0.72 (95% CI, 0.66-0.78).
  • Pattern similar across subgroups.
  • Reduction by statin type:
    • Atorvastatin (Lipitor, others): aHR, 0.98 (95% CI, 0.69-1.40).
    • Other statins: aHR, 0.76 (95% CI, 0.71-0.82).
    • Lipophilic: aHR, 0.86 (95% CI, 0.81-0.91).
    • Hydrophilic: aHR, 0.81 (95% CI, 0.49-1.37).

Study design

  • Danish population-based registry cohort study comparing:
    • 519,894 stroke-free individuals initiating statins in 2004-2013 (mean follow-up, 1330.2 days).
    • 1,222,185 propensity score-matched stroke-free statin nonusers (mean follow-up, 1416.2 days).
  • Main outcome: ICH.
  • Funding: Novo Nordisk Foundation.

Limitations

  • Possible healthy user bias.
  • Residual and unmeasured confounding.
  • Adherence unknown.
  • Inability to analyze ICH subtypes.