Table 2 Summary of clinical studies investigating the relationship between statin use and ICH
From: Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage
Study | Study design | Sample size, n (statin group, n) | Population or settings | Statin | Dose | Mean age, y; male (%) | Follow-Up in years | ICH patients, n (statin group, n) | Outcome |
|---|---|---|---|---|---|---|---|---|---|
[25] Dowlatshahi et al. 2012 | case–control study | 2466 (537 took statin before the occurrence of ICH, statins were discontinued on admission in 158 of 537) | be admitted to hospital with primary ICH, Canadian | No details | no details | 71; 53.6 % | / | / | Compared with nonusers, statin users were less likely to have severe strokes (54.7 % vs. 63.3 %) but had similar rates of poor outcome (70 % vs. 67 %) and 30-day mortality (36 % vs. 37 %). The patients who discontinued statins on admission were more likely to have severe stroke (65 % vs. 27 %, P < 0.01), poor outcome (90 % vs. 62 %, P < 0.01) |
[9] Flint et al. 2014 | retrospective cohort study | 3481 (1194) | be admitted to hospital with ICH, American | Lov, Sim, Ato | 10 mg/d, in atorvastatin-equivalent dose | 73.5; 50.1 % | No details | / | Improved 30-day survival: OR 4.25 (95 %CI 3.46–5.23) |
[26] Pan et al. 2014 | case–control study | 3218 (220) | be admitted to hospital with ischemic stroke, ICH or TIA, Chinese | No details | a/ | 62.1; 61.2 % | 1 | / | Improved 3 months and 1 year survival: 3 months-survival: OR 2.24 (95 %CI 1.49–3.36); 1 year survival: OR 2.04 (95 %CI 1.37–3.06) |
[7] Chen et al. 2014 | population-based prospective cohort study | 8333 (749) | be admitted to hospital with new-onset ICH, Taiwanese | Sim, Pra, Flu | 20 mg/d, in atorvastatin-equivalent dose | 59; 60.4 % | 2 | 746 (69) | Did not increase the risk of recurrent ICH: adjusted HR 1.044 (95 %CI 0.812–1.341) |
[33] Collins et al. 2004 | randomized controlled trails | 20,536 (10,269) | with a history of cardiovascular disease, other occlusive arterial disease, diabetes, or hypertension, British | Sim | 40 mg/d | 40–80; 75 % | 4.8 (mean duration) | 1029 (444) | No effect on ICH: OR 0.95 (95 %CI 0.65–1.40) |
[34] Hackam et al. 2012 | retrospective cohort study | 17,872 (8936) | with a history of acute ischemic stroke, Canadian | No details | / | 77.9; 46.3 % | 4.2 | 213 | No effect on ICH: HR 0.87 (95 %CI 0.65–1.17) |
[35] Hackam et al. 2011 | meta-analysis (23 randomized controlled trails, 12 cohort studies, 6 case–control studies, 1 case-crossover study) | 248,391 | Patients with atherosclerotic cardiovascular disease or risk factors for atherosclerosis, multicenter | No details | / | /,/ | 3.9 (IQR, 2.8–5.0) | 14,784 | No effect on ICH: random trials: OR 1.10 (95 % CI 0.86–1.14); cohort studies: OR 0.94 (95 % CI 0.81–1.10); case–control studies: OR 0.60 (95 % CI 0.41–0.88) |
[36] McKinney et al. 2012 | meta-analysis (31 randomized controlled trails) | 182,803 (91,588 in the active group and 91,215 in the control group) | Patients with a history of diabetes mellitus, hypertension, cardiovascular disease, stroke or smoking, multicenter | / | / | 62.6; 67.0 % | 3.9 (median length) | 676 (358 patients in the active group vs. 318 in the control group) | No effect on ICH: OR 1.08 (95 % CI 0.88–1.32) |
[21] Mustanoja et al. 2013 | observational registry | 964 (187 patients used statin before ICH) | ICH patients, Finnish | No details | / | 66; 57 % | No details | / | Premorbid statin use did not affect the outcome of ICH[in-hospital mortality: OR 1.11 (95 % CI 0.39–3.14); 3-month mortality: OR 1.57 (95 % CI 0.74–3.32); 12-month mortality: OR 0.97 (95 % CI 0.48–1.96)] |
[14] Lei et al. 2014 | meta-analysis (12 interventional or observational clinical studies) | 6961(1652 patients used statin before ICH and 5309 nonusers | ICH patients, multicenter | Pra, Sim, Ato | 10–40 mg/day | /,/ | No details | 2423 (569)a | No effect on in-hospital, 30-day and 90-day mortality: OR 0.85 (95 % CI 0.70–1.03) |
[37] Amarenco et al. 2006 | prospective random study | 4731 (2365) | with a history of an ischemic or hemorrhagic stroke or a TIA, multicenter | Ato | 80 mg/d | 62.7; 59.6 % | 4.9 (4.0–6.6) | 88 (55) | 5-year absolute reduction in the risk of fatal or nonfatal stroke: adjusted HR 0.84 (95%CI 0.71–0.99, P = 0.03) |
[10] Goldstein et al. 2007b | the post hoc analysis of prospective random study | 4731 (2365) | with a history of an ischemic or hemorrhagic stroke or a TIA, multicenter | Ato | 80 mg/d | 62.7; 59.6 % | 4.9 (4.0–6.6) | 88 (55) | Increased the risk of ICH: 2.3 % vs. 1.4 %, HR 1.68 (95 %CI 1.09–2.59) |
[1] Scheitz et al. 2014 | prospective cohort study | 1446 (317 used statins before intravenous thrombolysis) | acute ischemic stroke patients receiving intravenous thrombolysis, American | Sim, Ato, Pra, Flu, Ros | 20, 40, 80 mg/d, in simvastatin-equivalent dose | 66.5; 66.0 % | / | 53 | Enhanced the risk of sICH: adjusted OR 2.4 (95 %CI 1.1–5.3) and 5.3 (95 %CI 2.3–12.3)c |