Background

Statins are important components of secondary stroke prevention, but there is a concern they may increase the risk of intracerebral hemorrhage. Although this risk may have been overestimated, there is still an open question whether statin therapy should be continued, or even initiated, in patients who have had a recent intracerebral hemorrhage.

Aim

Our aim was to investigate the risk of statin use after an intracerebral hemorrhage with respect to recurrent intracerebral hemorrhage, stroke in general, and death.

Methods

This observational study was based on patients with a first intracerebral hemorrhage in 2004 through 2009. Clinical characteristics, index intracerebral hemorrhage, and recurrent intracerebral hemorrhages were identified by the Swedish Stroke Register; additional data on comorbidities and vital status were retrieved through record linkages to national registers. A propensity score for the likelihood of receiving statins at discharge was developed and used with other established risk factors in a multivariable analysis.

Results

Of 6082 intracerebral hemorrhage patients (mean age 69.6 years), 1097 (18%) were prescribed statins at discharge. During the follow-up (mean 3.1 years), 1434 (23.6%) deaths and 234 (3.8%) recurrent intracerebral hemorrhages were observed. Statin therapy was associated with a reduced risk of death (adjusted hazard ratio: 0.71; 95% confidence interval: 0.60–0.84) but not with the risk of recurrent intracerebral hemorrhage (adjusted hazard ratio: 0.82; 95% confidence interval: 0.55–1.22).

Conclusions

This study provides some reassurance that statins may be safe to use, in at least some patients, after an intracerebral hemorrhage. In patients with intracerebral hemorrhage, statin use was associated with a reduced risk of death, without an increased risk of recurrent intracerebral hemorrhage.

中文翻译：

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他汀类药物作为脑出血患者的二级预防措施

背景

他汀类药物是继发性中风预防的重要组成部分，但人们担心它们可能会增加脑出血的风险。尽管这种风险可能被高估了，但是对于最近有脑出血的患者，是否应该继续使用他汀类药物，或者甚至开始使用他汀类药物仍存在一个悬而未决的问题。

目标

我们的目的是研究脑出血后复发性脑出血，一般性中风和死亡方面使用他汀类药物的风险。

方法

这项观察性研究的依据是2004年至2009年首次发生脑出血的患者。瑞典卒中登记册确定了临床特征，指数性脑出血和复发性脑出血。通过与国家登记簿的记录联系，检索到有关合并症和生命状况的其他数据。制定出院时接受他汀类药物可能性的倾向评分，并与其他已确定的危险因素一起用于多变量分析。

结果

在6082名脑出血患者（平均年龄69.6岁）中，有1097名（18％）患者在出院时服用他汀类药物。在随访期间（平均3.1年），观察到1434（23.6％）例死亡和234例（3.8％）复发性脑出血。他汀类药物治疗与死亡风险降低相关（调整后的危险比：0.71； 95％置信区间：0.60-0.84），但与复发性脑出血的风险无关（调整后的危险比：0.82； 95％置信区间：0.55-1.22） ）。

结论

这项研究为脑出血后至少在某些患者中使用他汀类药物提供了一定的保证。在脑出血患者中，使用他汀类药物可降低死亡风险，而不会增加复发性脑出血的风险。