Statins and intracerebral hemorrhage: a retrospective cohort study
Hackam DG, Austin PC, Huang A, Juurlink DN, Mamdani MM, Paterson JM, Hachinski V, Li P, Kapral MK. Arch Neurol . 2011; 69(1):39-45. Epub 2011 Sep 12.
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.
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