Wednesday, February 23, 2011
statins stroke
Statin Use Following Intracerebral Hemorrhage: A Decision Analysis
Westover MB, Bianchi MT, Eckman MH, Greenberg SM
Arch Neurol. 2011 Jan 10 [Epub ahead of print]
Study Summary
For primary and secondary prevention of ischemic cardiovascular disease and stroke, statins are in widespread use and are rarely associated with serious adverse effects. However, findings from a recent study[1] suggested that statin use may be associated with increased risk for intracerebral hemorrhage (ICH). The goal of the present study was to determine whether this potential adverse effect outweighs the cardiovascular and cerebrovascular benefits in patients with higher baseline risk for ICH because of a previous history of ICH.
Using a Markov mathematical decision model, the investigators assessed the effect of statin use on life expectancy, measured as quality-adjusted life-years, in patients with previous ICH over a range of clinical parameters, including deep vs lobar hemorrhage location, ischemic cardiac and cerebrovascular risks, and magnitude of ICH risk associated with statin use.
For many clinical parameters over a wide range of values, avoiding statins was associated with better outcomes, especially in survivors of lobar ICH who are at highest risk for ICH recurrence. Compared with statin use, avoiding statins yielded a life expectancy gain of 2.2 quality-adjusted life-years in survivors of lobar ICH without previous cardiovascular events, and this net benefit was maintained even at the lower 95% confidence interval of the relative risk of statin-associated ICH. To favor statin therapy in patients with lobar ICH and a history of cardiovascular events, the annual recurrence risk for myocardial infarction would have to be greater than 90%.
Statin therapy was predicted to increase the baseline annual probability of recurrence of lobar ICH from approximately 14% to approximately 22%. For survivors of deep ICH, avoiding statin therapy for both primary and secondary prevention also was associated with better outcomes, although by a smaller margin than in patients with lobar ICH.
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References
- Goldstein MR, Mascitelli L, Pezzetta F. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology. 2009;72:1448-1449. Abstract
Authors and Disclosures
Author
Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
