Reader Response: Association Between Statin Use and Intracerebral Hemorrhage Location: A Nested Case-Control Registry Study
TomoyukiKawada, Professor, Nippon Medical School
Submitted December 21, 2022
Boe et al. evaluated the relationship between statin use and intracerebral hemorrhage (ICH) with special reference to ICH locations, duration, and intensity of statin use.1 The authors adopted a conditional logistic regression analysis, and the adjusted odds ratios (aORs) (95% confidence Intervals [Cis]) of current statin use for lobar and non-lobar ICH were 0.83 (0.70-0.98) and 0.84 (0.72-0.98), respectively. The significance of statin use was only observed in patients with duration of ≥5 years. In addition, aORs did not change by statin intensity, and the association did not vary by hematoma location. The authors set enough number of controls for keeping stable estimates. Regarding risk reduction of ICH by statin use, I present additional information regarding statin use and increased risk of ICH.
Pandit et al. conducted a meta-analysis of randomized controlled trials (RCTs) to assess the association between higher dose of various statins and risk of ICH among patients with cardiovascular disease (CVD).2 High dose of statins was defined as atorvastatin 80 mg, simvastatin 80 mg, pravastatin 40 mg, rosuvastatin 20 mg per day, and the pooled risk ratio (RR) (95% CI) of subjects with higher dose of statin for ICH was 1.53 (1.16-2.01). This means that high-dose statin therapy has a risk of ICH in patients with CVD, presenting discrepancy with no association between statin intensity and ICH risk. 1 It is possible that the progression of atherosclerosis in patients with CVD may interact with the risk of ICH by intensive statin therapy.
Wang et al. reported that pooled relative risk (95% CI) of high against low LDL-C concentrations for ICH was 0.62 (0.41–0.92) by compiling four prospective cohort studies.3 Regarding aggressive LDL-lowering therapy, caution should be taken with patients with previous ICH, very elderly patients, and patients with uncontrolled hypertension.4 I think that the relationship between statin use and risk of ICH should be specified by additional RCTs.
References
1. Boe NJ, Hald SM, Jensen MM, et al. Association between statin use and intracerebral hemorrhage location: A nested case-control registry study. Neurology. Published online December 7, 2022. doi: 10.1212/WNL.0000000000201664
2. Pandit AK, Kumar P, Kumar A, et al. High-dose statin therapy and risk of intracerebral hemorrhage: a meta-analysis. Acta Neurol Scand 2016;134(1):22-28.
3. Wang X, Dong Y, Qi X, et al. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke 2013;44(7):1833-1839.
4. Gurevitz C, Auriel E, Elis A,et al. The Association between low levels of low density lipoprotein cholesterol and intracerebral hemorrhage: Cause for concern? J Clin Med 2022;11(3):536.
Author disclosures are available upon request(journal@neurology.org).
Boe et al. evaluated the relationship between statin use and intracerebral hemorrhage (ICH) with special reference to ICH locations, duration, and intensity of statin use.1 The authors adopted a conditional logistic regression analysis, and the adjusted odds ratios (aORs) (95% confidence Intervals [Cis]) of current statin use for lobar and non-lobar ICH were 0.83 (0.70-0.98) and 0.84 (0.72-0.98), respectively. The significance of statin use was only observed in patients with duration of ≥5 years. In addition, aORs did not change by statin intensity, and the association did not vary by hematoma location. The authors set enough number of controls for keeping stable estimates. Regarding risk reduction of ICH by statin use, I present additional information regarding statin use and increased risk of ICH.
Pandit et al. conducted a meta-analysis of randomized controlled trials (RCTs) to assess the association between higher dose of various statins and risk of ICH among patients with cardiovascular disease (CVD).2 High dose of statins was defined as atorvastatin 80 mg, simvastatin 80 mg, pravastatin 40 mg, rosuvastatin 20 mg per day, and the pooled risk ratio (RR) (95% CI) of subjects with higher dose of statin for ICH was 1.53 (1.16-2.01). This means that high-dose statin therapy has a risk of ICH in patients with CVD, presenting discrepancy with no association between statin intensity and ICH risk. 1 It is possible that the progression of atherosclerosis in patients with CVD may interact with the risk of ICH by intensive statin therapy.
Wang et al. reported that pooled relative risk (95% CI) of high against low LDL-C concentrations for ICH was 0.62 (0.41–0.92) by compiling four prospective cohort studies.3 Regarding aggressive LDL-lowering therapy, caution should be taken with patients with previous ICH, very elderly patients, and patients with uncontrolled hypertension.4 I think that the relationship between statin use and risk of ICH should be specified by additional RCTs.
References
1. Boe NJ, Hald SM, Jensen MM, et al. Association between statin use and intracerebral hemorrhage location: A nested case-control registry study. Neurology. Published online December 7, 2022. doi: 10.1212/WNL.0000000000201664
2. Pandit AK, Kumar P, Kumar A, et al. High-dose statin therapy and risk of intracerebral hemorrhage: a meta-analysis. Acta Neurol Scand 2016;134(1):22-28.
3. Wang X, Dong Y, Qi X, et al. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke 2013;44(7):1833-1839.
4. Gurevitz C, Auriel E, Elis A,et al. The Association between low levels of low density lipoprotein cholesterol and intracerebral hemorrhage: Cause for concern? J Clin Med 2022;11(3):536.
Author disclosures are available upon request(journal@neurology.org).