“The significant reduction in total stroke and all-cause mortality more than offset any slight increase in ICH risk,” the authors comment.
Dr. James S. McKinney at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, in New Brunswick, and Dr. William J. Kostis with Massachusetts General Hospital in Boston, Massachusetts, explain that low cholesterol levels have been hypothesized to increase the risk of vessel rupture, and some studies have reported an association of hemorrhagic stroke to statin use. While some previous meta-analyses have found a trend toward an increased risk of ICH with statin use, others have not.
For the current study, the researchers identified 31 randomized clinical trials of statin therapy that reported data on ICH or hemorrhagic stroke. The trials included a total of 182,803 subjects, almost equally divided between an active treatment group and a control group.
The median follow-up was 46.8 months, during which time ICH occurred in 0.39% of those in the active treatment group versus 0.35% in the control group. “In our analysis, active therapy was associated with a nonsignificant increase in the risk of ICH (OR, 1.08),” Drs. McKinney and Kostis report.
The small nonsignificant excess of ICH was not related to the degree of LDL reduction or the level of LDL achieved, they found.
On the other hand, total stroke incidence was 3.13% in the active treatment group compared with 3.72% in the control group (odds ratio 0.84; p<0.0001). Similarly, statin therapy was associated with a significantly lower rate of all-cause mortality (10.67% vs 11.43%; OR 0.92; p=0.0007), according to the report.
The authors conclude, “These findings support the current recommendations to prescribe statins in otherwise appropriate patients.”