Statins not associated with intracerebral hemorrhage, meta-analysis indicates

A recent meta-analysis found no evidence of an association between statins and intracerebral hemorrhage (ICH).

Because a recent large, randomized controlled trial suggested a link between statin use and risk for ICH, the authors of the current study performed a large systematic review and meta-analysis of the existing literature to examine the potential association. They searched 17 electronic databases, manually screened bibliographies, reviewed proceedings abstracts, and consulted experts to find published and unpublished trials that included data on ICH and use of statins.

Studies were excluded if they combined statins with other classes of lipid-lowering drugs and if they only looked at ICH after thrombolysis for acute ischemic stroke. In the former case, however, the authors contacted study authors to determine whether data that analyzed statins separately were available. The authors calculated summary risk ratios and 95% CIs using DerSimonian-Laird random-effects models, and they analyzed the included studies separately by type (i.e., randomized trials, cohort studies and case-control studies). Results of the meta-analysis were published online Oct. 17 by Circulation.

Overall, data from 23 randomized trials and 19 observational studies, involving a total of 248,391 patients and 14,784 ICHs, were included. No association was seen between statins and ICH in randomized trials (risk ratio, 1.10; 95% CI, 0.86 to 1.41), cohort studies (risk ratio, 0.94; 95% CI, 0.81 to 1.10) or case-control studies (risk ratio, 0.60; 95% CI, 0.41 to 0.88). The case-control studies had substantial heterogeneity while the cohort studies and randomized trials did not. The authors performed sensitivity analyses according to characteristics of study design and patients as well as degree of cholesterol lowering, but the results did not markedly change.

The authors cautioned that their analysis did not allow access to individual patient data, that adherence to statin therapy was low in the observational studies, and that they could not determine the possible effect of statin use on different subtypes of ICH. However, they concluded that their large meta-analysis found no evidence indicating an association between ICH and statins, and noted that if such a risk does exist, it is probably small and does not outweigh statins' benefits. “Because risk factors for nonlobar [ICH] are similar to those for atherosclerotic events…, clinicians should continue to use treatment algorithms that base the initiation of statins on each individual's global risk for cardiovascular events,” they wrote.