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(Stroke. 2004;35:1360.)
© 2004 American Heart Association, Inc.

Original Contributions

Hypercholesterolemia, HMG-CoA Reductase Inhibitors, and Risk of Intracerebral Hemorrhage

A Case–Control Study

Daniel Woo, MD; Brett M. Kissela, MD; Jane C. Khoury, MS; Laura R. Sauerbeck, RN, MS; Mary A. Haverbusch, RN, BSN; Jerzy P. Szaflarski, MD, PhD; James M. Gebel, MD; Arthur M. Pancioli, MD; Edward C. Jauch, MD; Alexander Schneider, MD; Dawn Kleindorfer, MD Joseph P. Broderick, MD

From the Department of Neurology and the Neuroscience Institute (D.W., B.M.K., L.R.S., M.A.H., J.P.S., A.S., D.K., J.P.B.), Department of Environmental Health (J.C.K.), and Department of Emergency Medicine (A.M.P., E.C.J.), University of Cincinnati, Ohio; Department of Neurology (J.G.), University of Louisville, Kentucky.

Correspondence to Dr Daniel Woo, Department of Neurology, University of Cincinnati College of Medicine, 231 Bethesda Avenue ML 0525, Cincinnati, OH 45267-0525. E-mail Daniel.woo{at}uc.edu

Background and Purpose— Several studies have demonstrated an association between hypocholesterolemia and intracerebral hemorrhage (ICH). We tested the hypothesis that hypercholesterolemia or use of HMG-CoA reductase inhibitors (statin) agents, or both, are associated with ICH.

Methods— This study was part of the preplanned midway analysis of an ongoing, population-based, case-control study of the genetic and environmental risk factors of hemorrhagic stroke. Conditional stepwise logistic regression modeling was used to determine if self-reported hypercholesterolemia or statin use, or both, were independent risk factors for ICH.

Results— Between December 1, 1997, and June 30, 2000, 188 cases of ICH and 366 age-, race-, and gender-matched controls were enrolled. Hypercholesterolemia and statin use were less common among cases than controls: 25% versus 38% (P=0.003) and 9% versus 17% (P=0.03), respectively. Hypercholesterolemia with statin use was associated with less risk of ICH (OR=0.30; P=0.0008) in multivariable analysis after controlling for alcohol use, hypertension, previous stroke, first-degree relative with ICH, education level, and apolipoprotein E alleles.

Conclusion— Hypercholesterolemia was associated with a lower risk of ICH. We have not found an increased risk of ICH with the widespread use of statins in our population. Given the lack of cholesterol levels in the current study, further studies are needed to determine if lower cholesterol levels secondary to statin use bear the same risk as low cholesterol levels for ICH.

Key Words: stroke • hemorrhage • hypercholesterolemia • HMG-CoA reductase inhibitors • apolipoproteins • risk factors

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