David C. Anderson, MD
Do statins increase risk for intracerebral hemorrhage (ICH)?
Included studies reported data on statin use and incidence of ICH. Studies of intracranial hemorrhage after thrombolysis (intravenous or intraarterial) for acute ischemic stroke and those that did not provide data for statins separately from other lipid-lowering drugs were excluded. Primary outcome was ICH. Other outcomes were total and ischemic stroke.
MEDLINE, PreMEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Cochrane Health Technology Assessment Database, Cardiosource Clinical Trials, Database of Abstracts of Reviews of Effects, Healthstar, OVID Full Text Journals, Web of Science with Conference Proceedings, UpToDate Online, trial registers (International Standard Randomized Controlled Trial Number Register, ClinicalTrials.gov, Stroke Trials Registry), and Web sites (European Medicines Agency, US Food and Drug Administration, What's What Online) to Jun 2011; reference lists; and abstracts from cardiology, neurology, and endocrinology meetings were searched for randomized controlled trials (RCTs) and observational studies. Investigators were contacted. 23 RCTs (n = 130 443) and 19 observational studies met the selection criteria. Only the results of RCTs are reported here. 48% of RCTs were done in primary prevention settings; 52% were done in secondary prevention settings. Median trial follow-up was 3.9 years, median loss to follow-up was 0.09%, and 21 RCTs scored ≥ 3 out of 5 on the Jadad scale for methodological quality.
0.38% of patients in RCTs had an ICH. Statin use was not associated with increased risk for ICH (Table). Statins reduced risk for total and ischemic stroke (Table).
Statins do not increase risk for intracerebral hemorrhage.
*Abbreviations defined in Glossary. RRI, RRR, and CI calculated from data in article using a random-effects model.
†Information provided by author.
‡Includes ischemic, hemorrhagic, and unclassified stroke (information provided by author).
Anderson DC. Review: Statins do not increase risk for intracerebral hemorrhage. Ann Intern Med. 2012;156:JC3–6. doi: 10.7326/0003-4819-156-6-201202210-02006
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Published: Ann Intern Med. 2012;156(6):JC3-6.
Cardiology, Coronary Risk Factors, Dyslipidemia, Neurology, Prevention/Screening.
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