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J Neurol Neurosurg Psychiatry. 2018 Aug 27. pii: jnnp-2018-318483. doi: 10.1136/jnnp-2018-318483. [Epub ahead of print]

Statins and the risk of intracerebral haemorrhage in patients with stroke: systematic review and meta-analysis.

Author information

1
Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL, London, UK.
2
The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
3
Department of Statistical Science, UCL, London, UK.
4
Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL, London, UK d.werring@ucl.ac.uk.

Abstract

OBJECTIVE:

Whether statins increase the risk of intracerebral haemorrhage (ICH) in patients with a previous stroke remains uncertain. This study addresses the evidence of statin therapy on ICH and other clinical outcomes in patients with previous ischaemic stroke (IS) or ICH.

METHODS:

A systematic literature review and meta-analysis was performed in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess observational and randomised studies comparing statin therapy with control (placebo or no treatment) in patients with a previous ICH or IS. The risk ratios (RR) for the primary outcome (ICH) and secondary outcomes (IS, any stroke, mortality and function) were pooled using random effects meta-analysis according to stroke subtype.

RESULTS:

Forty-three studies with a combined total of 317 291 patient-years of follow-up were included. In patients with previous ICH, statins had no significant impact on the pooled RR for recurrent ICH (1.04, 95% CI 0.86 to 1.25; n=23 695); however, statins were associated with significant reductions in mortality (RR 0.49, 95% CI 0.36 to 0.67; n=89 976) and poor functional outcome (RR 0.71, 95% CI 0.67 to 0.75; n=9113). In patients with previous IS, statins were associated with a non-significant increase in ICH (RR 1.36, 95% CI 0.96 to 1.91; n=103 525), but significantly lower risks of recurrent IS (RR 0.74, 95% CI 0.66 to 0.83; n=53 162), any stroke (RR 0.82, 95% CI 0.67 to 0.99; n=55 260), mortality (RR 0.68, 95% CI 0.50 to 0.92; n=74 648) and poor functional outcome (RR 0.83, 95% CI 0.76 to 0.91; n=34 700).

CONCLUSIONS:

Irrespective of stroke subtype, there were non-significant trends towards future ICH with statins. However, this risk was overshadowed by substantial and significant improvements in mortality and functional outcome among statin users.

TRIAL REGISTRATION NUMBER:

CRD42017079863.

PMID:
30150320
DOI:
10.1136/jnnp-2018-318483

Conflict of interest statement

Competing interests: OJZ, GB and GA have no relevant conflicts. DJW was UK chief investigator for A9951024 (Pfizer) and has received consultancy and lecture fees from Bayer.

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