Statins May Be Inadvisable After Hemorrhagic Stroke
Statin users with history of lobar stroke may be at particular risk for recurrent bleed
TUESDAY, Jan. 11 (HealthDay News) -- Statin use for primary or secondary prevention of cardiovascular events may be inadvisable in patients with a high risk of recurrent intracerebral hemorrhage (ICH), according to a study published online Jan. 10 in the Archives of Neurology.
M. Brandon Westover, M.D., Ph.D., of Massachusetts General Hospital in Boston, and colleagues assessed the risks and benefits of statin therapy in a simulated clinical trial. They evaluated life expectancy, measured as quality-adjusted life-years, against a number of parameters, including hemorrhage location (deep versus lobar), risks of ischemic cardiac and cerebrovascular events, and the magnitude of statin-associated ICH risk.
The researchers found that avoiding statins was favored in a number of situations, particularly in patients who had lobar ICH, because they were at highest risk of recurrence. Among survivors of lobar stroke with no history of cardiovascular events, they found a life expectancy gain of 2.2 quality-adjusted life-years if statins were avoided. In patients with lobar ICH who had prior cardiovascular events, the annual recurrence risk of myocardial infarction would have to exceed 90 percent for the benefits of statins to outweigh the risk of ICH. For survivors of deep ICH, avoiding statins was also favored, but by a smaller margin.
"Mathematical decision analysis of the available data suggests that, because of the high risk of recurrent ICH in survivors of prior hemorrhagic stroke, even a small amplification of this risk by use of statins suffices to recommend that they should be avoided after ICH," the authors write.