Statins: risk/benefit in stroke

A new meta-analysis has concluded that the benefit of statin therapy in the prevention of ischemic stroke "greatly exceeds" the risk for intracerebral hemorrhage (ICH).

The meta-analysis was released on AAN.com as part of the 2020 American Academy of Neurology Science Highlights. The meeting, like many others, was cancelled because of the COVID-19 pandemic.

Some previous studies have suggested that statin therapy may be associated with an increased risk for ICH, especially at higher doses. Other studies, however, have failed to confirm this and have shown an increase in cardiovascular events if statins are stopped.

To look further into this issue, the researchers conducted a meta-analysis of 19 clinical studies involving patients who had a history of cardiovascular or cerebrovascular events and who had been treated with statins. A total of 35,842 patients were included.

Results showed that statin use was not significantly associated with the risk for combined primary and secondary ICH (relative risk [RR], 1.03; 95% confidence interval [CI], 0.85 - 1.08). But the risk for cerebral ischemia (stroke and transient ischemic attack) was significantly lower in those who received statins (RR, 0.79; 95% CI, 0.61 - 0.87).

A sensitivity analysis showed a trend toward a higher risk for secondary ICH among those who were assigned to statin treatment (odds ratio, 1.87; 95% CI, 0.91 - 3.86).

While this may suggest an increased risk of secondary ICH, when we look at the big picture, putting all the data together, and given that ischemic events are far more common than ICH, the risk of stopping statins and losing the protection against ischemic events is probably greater than any harm even in patients with underlying risk factors for ICH.