Are fears regarding statins posing a risk to brain hemorrhage patients unfounded?
The patients who took statins following an intracerebral hemorrhage were found to have better 30-day survival outcomes and to be more likely to be discharged home or to an acute rehabilitation facility. The findings of this new study are published in JAMA Neurology.
Previous research has found that statins - a class of medicines frequently used to lower blood cholesterol levels - can reduce the risk of ischemic stroke among people who have a history of ischemic stroke.
Although ischemic strokes and intracerebral hemorrhages (also referred to as hemorrhagic strokes) have different primary causes, they share several causes for secondary brain injury - such as inflammation - that the use of statins could potentially influence.
While previous studies have found associated benefits with statin use and ischemic stroke, research is conflicted about statin use and intracerebral hemorrhage (ICH).
Although several studies have found no increased risk of ICH with outpatient statin use, the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial reported an increased risk of ICH in patients randomly given a high dose of a particular statin.
Contrasting findings may be influencing clinicians and making them wary of prescribing statins to patients with a history of ICH. This uncertainty has made it difficult to know what the best course of action is for patients presenting with ICH who are already using statins.
Measuring mortality and discharge disposition
As a result, a team of researchers from Kaiser Permanente Northern California engaged in a study of 3,481 patients with ICH who were admitted to 20 hospitals situated within a large health care system over the course of 10 years. The researchers analyzed both their medical and pharmacy records during this time.
The authors observed that 2,321 of these patients did not use statins prior to their ICH. As inpatients, 425 (18.3%) of them then received statins. Conversely, of the 1,160 patients who had used statins as outpatients, 391 (33.7%) did not use statins as inpatients.
Overall, the patients who received statins as inpatients tended to experience better health outcomes. Inpatient statin users had a 30-day mortality rate of 18.4%, compared with a rate of 38.7% for patients who did not use statins as inpatients.
Patients receiving statins as inpatients were discharged home or to an acute rehabilitation facility in 51.1% of cases, whereas only 35% of those not treated with statins were discharged in this manner.
Outpatient statin users who then stopped using statins after their hospitalizations for ICH had a mortality rate of 57.8%, compared with a mortality rate of 18.9% for patients who used statins before and during their hospitalization.
Discontinuation of statin use also reduced the likelihood of patients being discharged during the 30-day period. Patients whose statin use was stopped upon hospitalization were only discharged home or to a rehabilitation facility 22.3% of the time, compared with 49.8% of the time for patients who continued to use statins.
Further research into statin therapy
"Statin use is associated with improved outcomes after ICH, and the cessation of statin use is associated with worsened outcomes after ICH," conclude the study authors. This association was also found to remain after controlling for variables such as medical co-morbidities and ICH severity.
The authors acknowledge that their study has some limitations. They had conducted a retrospective cohort study and data was not available for every patient regarding ICH severity or the use of medications that could have affected the patients' outcomes. Specific data on the cause of death for patients was also unavailable.
Restricting the study to inpatient statin use also meant that the authors were unable to address whether it is advisable for statin use to be continued in the long term. The discharge of patients is not directly an assessment of functional outcome and so may not be the best measure for their purposes.
In an editorial linked to the study, Dr. Marco Gonzalez-Castellon and Dr. Randolph Marshall, of Columbia University Medical Center, New York, state that further research is required before the statin use and ICH debate is settled, though the study provides enough data to potentially inform initial post-ICH treatment.
"Their study thus requires validation in a prospective cohort. For now, however, it provides sufficient evidence to recommend at least the continuation of statin therapy after nonamyloid ICH for at least 30 days after the initial event. Further study of this important management question is warranted."
This study is the latest addition to a growing body of research on the utilization of statins. Previously, Medical News Today reported on a study investigating whether statins could help speed up wound healing after cardiac surgery.