Prior Statin Use Reduces Mortality in Intracerebral Hemorrhage

Naval, Neeraj S.; Abdelhak, Tamer; Zeballos, Paloma; Urrunaga, Nathalie H.; Mirski, Marek A.; Carhuapoma, J. Ricardo

doi:10.1007/s12028-007-0080-2

Cited by 72 publications

(61 citation statements)

References 40 publications

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“…18 The potential benefits of statin therapy for human ICH was also described in a recent study in which it was associated with reduced 30-day mortality, but not improved functional outcome. 19 Conflicting results are otherwise found in the literature. The NASIS study showed a reduction of mortality and neurological disability with statin use 20 while FitzMaurice et al failed to reproduce this relationship.…”

Section: Discussionmentioning

confidence: 98%

Statins May Increase Intracerebral Hemorrhage Volume

Ricard

Garant

Carrier

et al. 2010

Can. j. neurol. sci.

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Several epidemiological studies have demonstrated an association between hypocholesterolemia and the incidence of intracerebral hemorrhage (ICH).1-3 HMG-CoA reductase inhibitors (statin) may theoretically increase the risk of cerebral hemorrhage, given its cholesterol-lowering effect. In addition, statins have been associated with decreased platelet function via direct influence on platelet membrane and inhibition of PAR-1, which is a cell-bound protein that links platelet activation. [4][5][6] An exploratory analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial found that statins overall effect included an increase in the number of treated patients having hemorrhagic stroke (n 55 for active treatment vs n 33 for placebo) with an unadjusted HR 1.68. 7 The Heart Protection Study (HPS) earlier described this ABSTRACT: Background: Some studies have suggested an association between hypocholesterolemia and intracerebral hemorrhage (ICH). In the SPARCL trial, statin use increased ICH risk. We tested the hypothesis that use of statins affects the volume of spontaneous ICH and contributes to the progression of ICH volume between baseline and follow-up CT scans. Methods: Consecutive cases of spontaneous ICH were reviewed. Secondary causes were excluded. We measured ICH volume on the baseline and follow-up CT scans using the AxBxC/2 method. Multivariate analysis and logistic regression modeling were used. The primary outcome was the ICH volume on the baseline CT scan. Secondary outcomes included volume variation between the baseline and the first follow up CT scans and death. Results: Of 303 subjects, 71 were taking a statin at the time of the ICH (23%). Statin users were significantly more likely to be younger, to have co-morbidities and take anticoagulant or anti-platelet medication. They also had a higher baseline ICH volume than non-statin users (median 31.

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Section: Discussionmentioning

confidence: 98%

Statins May Increase Intracerebral Hemorrhage Volume

Ricard

Garant

Carrier

et al. 2010

Can. j. neurol. sci.

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“…20,21 A retrospective study found that prior statin use was associated with reduced perihematomal edema and improved survival in a series of patients with nontraumatic intracerebral hemorrhage. 22,23 Analysis of SPARCL data found that statin treatment was associated with an increased risk of hemorrhagic stroke in subjects with prior stroke that was independent of other factors. 1,19 Although limited by small numbers and therefore low statistical power, the current analysis found no difference in the outcomes of hemorrhagic strokes (Figure, bottom panel).…”

Section: Discussionmentioning

confidence: 99%

Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

Goldstein

Amarenco

Zivin

et al. 2009

Stroke

117

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on behalf of the SPARCL InvestigatorsBackground and Purpose-Laboratory experiments suggest statins reduce stroke severity and improve outcomes. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial was a placebo-controlled, randomized trial designed to determine whether treatment with atorvastatin reduces strokes in subjects with recent stroke or transient ischemic attack (nϭ4731). We analyzed SPARCL trial data to determine whether treatment favorably shifts the distribution of severities of ischemic cerebrovascular outcomes. Methods-Severity was assessed with the National Institutes of Health Stroke Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. Results-Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5 or 4), moderate (modified Rankin Scale score 3 or 2), and mild (modified Rankin Scale score 1 or 0) outcome ischemic strokes and transient ischemic attacks and an increase in the proportion of event-free subjects randomized to atorvastatin (PϽ0.001 unadjusted and adjusted). Results were similar for all outcome events (ischemic and hemorrhagic, PϽ0.001 unadjusted and adjusted) with no effect on outcome hemorrhagic stroke severity (Pϭ0.174 unadjusted, Pϭ0.218 adjusted). If the analysis is restricted to those having an outcome ischemic stroke (ie, excluding those having a transient ischemic attack or no event), there was only a trend toward lesser severity with treatment based on the modified Rankin Scale score (Pϭ0.0647) with no difference based on the National Institutes of Health Stroke Scale or Barthel Index. Conclusion-The

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“…Clinical data on statins in ICH is mixed. A small retrospective study of ICH found that pre-stroke statin use was associated with a reduction in mortality 70 and perihematomal DIDs ϭ delayed ischemic deficits; DRS ϭ disability rating score; GOS ϭ Glasgow outcome score; mRS ϭ modified Rankin scale; NIHSS ϭ National Institutes of Health stroke scale; SAH ϭ subarachnoid hemorrhage; TBI ϭ traumatic brain injury.…”

Section: Clinical Experience With Statins For the Treatment Of Acute mentioning

confidence: 99%

Statins in Traumatic Brain Injury

Wible

Laskowitz

2010

Neurotherapeutics

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Summary: Traumatic brain injury (TBI) is a common cause of long-term neurological morbidity, with devastating personal and societal consequences. At present, no pharmacological intervention clearly improves outcomes, and therefore a compelling unmet clinical need remains. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or "statins," offer a potential novel therapeutic strategy for TBI. Statins are well tolerated, easy to administer, and have a long clinical track record in critically ill patients. Their side effects are well defined and easily monitored. Preclinical studies have shown significant benefit of statins in models of TBI and related disease processes, including cerebral ischemia, intracerebral hemorrhage, and subarachnoid hemorrhage. In fact, multiple mechanisms have been defined by which statins may exert benefit after acute brain injury. Statins are currently positioned to be translated into clinical trials in acute brain injury and have the potential to improve outcomes after TBI.

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Prior Statin Use Reduces Mortality in Intracerebral Hemorrhage

Abstract: The significant association of prior statin use with decreased mortality warrants prospective evaluation of the use of statins following ICH.

Cited by 72 publications

References 40 publications

Statins May Increase Intracerebral Hemorrhage Volume

Statins May Increase Intracerebral Hemorrhage Volume

Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

Statins in Traumatic Brain Injury

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