Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage

Abstract

Hyperlipidemia is common in patients with intracerebral hemorrhage (ICH). Accumulating evidence indicates that patients with ICH are at risk for future hemorrhage recurrence, cardiovascular disease, and ischemic stroke and highlights the importance of secondary prevention of vascular events after ICH. Although the benefits of intensive treatment of hyperlipidemia for reducing ischemic cardiac and vascular events in patients with ischemic stroke are well established, the benefit versus harm in patients with ICH are less clear. Epidemiological studies suggest that hyperlipidemia is protective against ICH and that intensive lowering of lipids is associated with increased risk for ICH. Similarly, although currently available lipid-lowering treatments have been thoroughly studied in patients with ischemic cardiac and vascular disease, only few randomized trials of these therapies included a very small number of patients with history of ICH. Thus, limiting any definitive conclusions regarding the safety and net benefit of these treatments in ICH populations. Currently, there is no consensus regarding the optimal strategy for management of hyperlipidemia after ICH. In this article, we review relevant literature to outline the competing risks and benefits of lipid-lowering treatments in this vulnerable patient population. We suggest a treatment paradigm based on available data but note that data from dedicated randomized trials are needed to build the necessary evidence to guide optimal lipid-lowering strategy in patients with a history of ICH.

High-intensity versus moderate-intensity statin treatment for patients with ischemic stroke: Nationwide cohort study

“…If true, the explanations for these findings are not clear, and it was beyond the scope of this study to further disentangle the presumed benefit of high-intensity statins in reducing non-cardiovascular mortality. Consistent with previous reports, 8,25 we found no association between statin intensity and risk of hemorrhagic stroke.…”

“…5,7 The SPARCL trial did not investigate intensity or dose-response relations. 6 Additionally, some studies found dose-related side effects of statin use, such as increased risk of hemorrhagic stroke, 6,8 diabetes, impaired liver function, and proteinuria. 5 We therefore examined the effectiveness and safety of initiation of high-intensity statins compared with moderate-intensity statins in patients with ischemic stroke.…”

Major Adverse Cardiovascular Events After Intracerebral Hemorrhage—It’s All About Location, Location, Location

“…7 The present study 5 provides novel insight into the risk stratification of MACE after ICH to help delineate the high-risk group that can then be targeted with optimal secondary stroke prevention strategies. Although trials investigating the safety and efficacy of anticoagulation in ICH survivors with atrial fibrillation 8 and statin therapies in patients with lobar ICH are ongoing, 9 given the emerging association between ICH and future ischemic events even in the absence of atrial fibrillation, trials examining the net benefit of antiplatelet and lipidlowering therapy after ICH, particularly deep hemorrhages, are warranted.…”

Focused Update on Vascular Risk and Secondary Prevention in Survivors of Intracerebral Hemorrhage

“…In this focused updated, Shomanesh and selim review existing literature to outline the competing risks of increased propensity for ICH and benefits of reducing ischemic events of lipid lowering treatments in ICH population. They suggest a treatment paradigm based 8 on available data, but appropriately note that data from dedicated randomized trials are needed to build the necessary evidence to guide optimal lipid-lowering strategy in patients with a history of ICH.…”