Does the Pre- or Post-stroke Statin Therapy Increase the Risk of Intracerebral Hemorrhage in Post-stroke Patients? A Meta-analysis of Randomized and Nonrandomized Studies
Ammad Ishfaq1, Muhammad Ishfaq2, Fnu Abhi Pandhi3, Aman Deep4, Ana Hosseinzadeh Maleki5, Reza Bavarsad Shahripour5
1Neurology, Zeenat Qureshi Stroke Institute, 2Department of Neurology, UTHSC, 3UTHSC Dept of Neurology, 4University of Tennessee Health Science Center Neurology, 5University of Tennessee
Objective:
The role of statin in primary and secondary prevention and the risk of intracerebral hemorrhage. 
Background:

The association of statin and intracerebral hemorrhage risk is controversial. We conducted this meta-analysis to assess the safety of statin by estimating the risk versus benefit in terms of cerebral hemorrhagic and ischemic events.

Design/Methods:

A total of 19 clinical studies met the inclusion criteria and were included in the meta-analysis. We calculated pooled risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. The primary endpoint was intracerebral hemorrhage. Secondary endpoints were ischemic stroke and transient ischemic attack. 

Results:

A total of 35,842 were included in this metanalysis. The risk of combined primary and secondary intracerebral hemorrhage was not significantly associated with statin (RR 1.03; 95% CI 0.85-1.08). Sensitivity analysis showed a trend toward a higher risk of secondary intracerebral hemorrhage among those who were assigned to statin treatment (OR 1.87, 95% CI .91-3.86). The risk of cerebral ischemia (stroke and transient ischemic attack) was significantly lower in subjects assigned to statin treatment (RR 0.79; 95% CI 0.61-0.87).  

Conclusions:

The benefits of lipid-lowering therapy in the prevention of ischemic stroke greatly exceed the risk of ICH.