Abstract
Background and ObjectivesSurvivors of spontaneous intracerebral hemorrhage (ICH) may have indications for statin therapy. The effect of statins on the risk of subsequent hemorrhagic and ischemic stroke (IS) in this setting is uncertain. We sought to determine the risk of any stroke (ischemic stroke, IS or recurrent ICH), IS, and recurrent ICH associated with statin use among ICH survivors.MethodsUsing the Danish Stroke Registry, we identified all patients admitted to a hospital in Denmark (population 5.8 million) with a first-ever ICH between January 2003 and December 2021 who were aged 50 years or older and survived >30 days. Patients were followed up until August 2022. Within this cohort, we conducted 3 nested case-control analyses for any stroke, IS, and recurrent ICH. We matched controls for age, sex, time since first-ever ICH, and history of prior IS. The primary exposure was statin use before or on the date of subsequent stroke or the equivalent date in matched controls. Using conditional logistic regression, we calculated adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) for any stroke, IS, and recurrent ICH associated with statin exposure.ResultsWe identified 1,959 patients with any stroke (women 45.3%; mean [SD] age, 72.6 [9.7] years) who were matched to 7,400 controls; 1,073 patients with IS (women 42.0%; mean [SD] age, 72.4 [10.0] years) who were matched to 4,035 controls and 984 patients with recurrent ICH (women 48.7%; mean [SD] age, 72.7 [9.2] years) who were matched to 3,755 controls. Statin exposure was associated with a lower risk of both any stroke (cases 38.6%, controls 41.1%; aOR 0.88; 95% CI 0.78-0.99) and IS (cases 39.8%, controls 41.8%, aOR 0.79; 95% CI 0.67-0.92), but was not associated with recurrent ICH risk (cases 39.1%, controls 40.8%, aOR 1.05; 95% CI 0.88-1.24).DiscussionExposure to statins was not associated with an increased risk of recurrent ICH but was associated with a lower risk of any stroke, largely due to a lower risk of IS. Confirmation of these findings in randomized trials is needed.Classification of EvidenceThis study provides Class III evidence that statin use in patients with ICH is associated with a lower risk of any stroke and IS and not with increased risk of recurrent ICH.
| Original language | English |
|---|---|
| Pages (from-to) | E1793-E1806 |
| Journal | Neurology |
| Volume | 101 |
| Issue number | 18 |
| DOIs | |
| State | Published - Oct 31 2023 |
Bibliographical note
Publisher Copyright:© American Academy of Neurology.
Funding
The project received funding from the Novo Nordisk Foundation (grant no. NNF20OC0064637). D. Gaist received speaker honoraria from Bristol-Myers Squibb and Pfizer outside the submitted work; L.A. García Rodríguez reports no disclosures relevant to the manuscript; J. Hallas has participated in postauthorization safety studies funded by Pfizer, Menarini, Leo Pharma, and Novo Nordisk, with money paid to his employer and with no personal fees; S.M. Hald reports no disclosures relevant to the manuscript; S. Möller reports no disclosures relevant to the manuscript; B.B. Høyer reports no disclosures relevant to the manuscript; M. Selim receives support from the NIH (NINDS; U01NS102289, and NIA; UF1NS120871) and serves as the Principal Investigator for the SATURN trial, he serves as a consultant/Advisory Board member for MedRhythms Inc. and MexBrain; L.B. Goldstein reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
| Funders | Funder number |
|---|---|
| MedRhythms Inc. | |
| National Institutes of Health (NIH) | |
| National Institute on Aging | UF1NS120871 |
| National Institute of Neurological Disorders and Stroke | U01NS102289 |
| Bristol-Myers Squibb | |
| Pfizer | |
| Novo Nordisk Fonden | NNF20OC0064637 |
ASJC Scopus subject areas
- Clinical Neurology