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To the Editor:
The investigators of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study1 analyze the increased risk of hemorrhagic stroke in patients with a history of cerebrovascular disease treated with statins. Since statin use is associated with an increased risk of hemorrhagic stroke in patients with a history of cerebrovascular disease, this study is important because it identifies at-risk subgroups of patients.2
The authors emphasize that hemorrhagic stroke as an entry event is associated with hemorrhagic stroke during follow-up. Since patients with hemorrhagic stroke are usually not treated with statins for secondary prevention, this observation is of minor clinical importance. Far more interesting is the increased risk of hemorrhagic stroke in patients with lacunar stroke, caused by cerebral small vessel disease (hazard ratio [HR] 4.99, 95% confidence interval [CI] 1.71 to 14.61), treated with statins. The authors discuss that increased hemorrhagic strokes in small vessel disease might …
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