Statins and intracerebral hemorrhage: a retrospective cohort study

Background — A recent post hoc analysis of a large randomized trial in patients with cerebrovascular disease suggested that statins may increase the risk of intracerebral hemorrhage (ICH).

Objective — To examine the association between statins and ICH in patients with recent ischemic stroke in a population-based setting.

Design — Retrospective propensity-matched cohort study with accrual from July 1, 1994, to March 31, 2008.

Setting — Ontario, Canada.

Participants — A total of 17 872 patients aged 66 years and older who initiated statin therapy following acute ischemic stroke and were followed for a median of 4.2 years (interquartile range, 2.4-5.0 years). To enhance causal inference, the researchers conducted several tests of specificity to exclude healthy user bias in this sample.

Main Outcome Measure — Hospitalization or emergency department visit for ICH defined using validated diagnosis coding.

Results — Overall, 213 episodes of ICH occurred. In the primary analysis comparing statin users with nonusers, the researchers found no association between statins and ICH (hazard ratio = 0.87; 95% confidence interval, 0.65-1.17). Subgroup and dose-response analyses yielded similar results. In tests of specificity, statin therapy was not associated with bone mineral density testing, vitamin D or B(12) screening, gastrointestinal endoscopy, or elective knee arthroplasty, suggesting that results were not due to healthy user bias or differences in quality of care.

Conclusion — Statin exposure following ischemic stroke was not associated with ICH.