Statin Use May Lower Risk for Any Stroke in Patients With Spontaneous ICH

People who receive statin therapy following a spontaneous intracerebral hemorrhage (ICH) are not at greater risk of developing recurrent ICH but do have a lower risk for any stroke, mainly due to a lower risk for ischemic stroke. However, researchers caution these findings need to be confirmed in randomized trials. These are the results of a study published in Neurology.

Previous research has found high-dose atorvastatin therapy following stroke increased the risk for future ICH. However, subsequent research has yielded conflicting findings regarding the association of statin use with risks for ischemic stroke and recurrent ICH, following an initial ICH.

For this study, the researchers reviewed 19 years of patient data from the Danish Stroke Registry. These patients were aged 50 and older, presented with a first-time (index) ICH between January, 2003 and December, 2021, and had survived at least 30 days following that event. Of these 15,151 patients, 1959 had had a subsequent stroke, at a mean age of 73; 1073 patients had a subsequent ischemic stroke and 984 had a recurrent ICH.

In a nested case-control design, patients who experienced a second stroke were matched 1:4 to control individuals, who had experienced an initial ICH but no subsequent cerebrovascular event. This study design offered the advantage of controlling for changes in statin prescribing practices over time. Data on duration and recency of statin therapy, and severity of stroke, were examined between 30 days after the index ICH and either a subsequent stroke, death, loss to follow-up, or the end of the study period in August, 2022.

The researchers found that patients who were currently taking statins and had been taking them for at least a year had a lower risk for any subsequent stroke (adjusted OR [aOR], 0.84, 95% CI, 0.73–0.96) or ischemic stroke (aOR, 0.74, 95% CI, 0.61–0.89). Both high and low-to-moderate doses provided this protective effect. The decreased risk for any stroke was attributed to lower risk for ischemic stroke, although a separate analysis of a smaller dataset suggested that the protective effect was greater if the index ICH was non-lobar.

Cases of recurrent ICH were more severe than ischemic stroke after the index ICH, and had a higher 30-day fatality rate. However, current use of a statin was not associated with risk of recurrent ICH (aOR, 1.05, 95% CI, 0.88–1.24). This was true regardless of intensity (dosage) or duration of statin therapy.

Study limitations include the primarily European study population, which may limit generalizability of these findings; and use of proxy measures, instead of direct data, in modeling to control for blood pressure and lipids, and alcohol and tobacco use. Also missing were data on patients’ apolipoprotein E variant status, which may increase ICH risk.

“Our novel results on the risk of recurrent-ICH by location, although limited, support our conclusion regarding the lack of association between statin use and risk of recurrent-ICH,” the researcher stated. “This is inconsistent with recent meta-analyses that suggest a higher risk of recurrent ICH when statins are used for secondary stroke prevention.”

Disclosures: Several study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.