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(Stroke. 2008;39:2151.)
© 2008 American Heart Association, Inc.

Research Letters

Effect of Statins on Intracerebral Hemorrhage Outcome and Recurrence

Emilie FitzMaurice, AB; Lauren Wendell, MS; Ryan Snider, AB; Kristin Schwab, BA; Rishi Chanderraj, BS; Cathrine Kinnecom, MS, RN; Kaveer Nandigam, MD; Natalia S. Rost, MD; Anand Viswanathan, MD, PhD; Jonathan Rosand, MD, MS; Steven M. Greenberg, MD, PhD Eric E. Smith, MD, MPH, FRCPC

From the Hemorrhagic Stroke Research Program, Department of Neurology (E.F., L.W., R.S., K.S., R.C., C.K., K.N., N.S.R., A.V., J.R., S.M.G., E.E.S.) and the Center for Human Genetics Research (N.S.R., J.R.), Massachusetts General Hospital, Boston.

Correspondence to Dr Eric Smith, Associate Director of Acute Stroke Services, Mass General Hospital, Assistant Professor of Neurology, Harvard Medical School, CPZ 300, Mass General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail eesmith{at}partners.org

Background and Purpose— 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been associated with improved outcome after ischemic stroke and subarachnoid hemorrhage but an increased risk of incident intracerebral hemorrhage (ICH). We investigated (1) whether statin use before ICH was associated with functional independence at 90 days, and (2) whether survivors exposed to statins after ICH had an increased risk of recurrence.

Methods— We analyzed 629 consecutive ICH patients with 90-day outcome data enrolled in a prospective cohort study between 1998 to 2005. Statin use was determined by patient interview at the time of ICH and supplemented by medical record review. Independent status was defined as Glasgow Outcome Scale 4 or 5. ICH survivors were followed by telephone interview every 6 months.

Results— Statins were used by 149/629 (24%) before ICH. There was no effect of pre-ICH statin use on the rates of functional independence (28% versus 29%, P=0.84) or mortality (46% versus 45%, P=0.93). Medical comorbidities and warfarin use were more common in statin users. Hematoma volumes were similar (median 28 cm³ in pre-ICH statin users compared to 22 cm³ in nonusers, P=0.18). The multivariable-adjusted odds ratio for independent status in pre-ICH statin users was 1.16 (95% CI 0.65 to 2.10, P=0.62). ICH survivors treated with statins after discharge did not have a higher risk of recurrence (adjusted HR 0.82, 95% CI 0.34 to 1.99, P=0.66).

Conclusions— Pre-ICH statin use is not associated with improved ICH functional outcome or mortality. Post-ICH statin use is not associated with an increased risk of ICH recurrence.

Key Words: intracerebral hemorrhage • outcome • statins

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