Published Online
on January 3, 2008

A more recent version of this article appeared on February 1, 2008

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Submitted on March 21, 2007
Revised on May 29, 2007
Accepted on June 5, 2007

Statin Treatment and the Occurrence of Hemorrhagic Stroke in Patients With a History of Cerebrovascular Disease

Mervyn D.I. Vergouwen MD^*; Rob J. de Haan PhD; Marinus Vermeulen MD, PhD; and Yvo B.W.E.M. Roos MD, PhD

From the Departments of Neurology (M.D.I.V., M.V., Y.B.W.E.M.R.) and Clinical Epidemiology and Biostatistics (R.J.d.H.), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

^* To whom correspondence should be addressed. E-mail: m.d.vergouwen{at}amc.uva.nl.

Background and Purpose—The recently published Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed that statins exert a marginally beneficial effect on stroke prevention in patients with a history of cerebrovascular disease. Interestingly, the magnitude of the beneficial effect shown in this study is smaller than in similar studies, which included patients without a history of cerebrovascular disease. In SPARCL, an increased occurrence of hemorrhagic strokes in patients on statin treatment was observed, an effect that was also earlier described in the Heart Protection Study in a subgroup of patients with a history of cerebrovascular disease. The purpose of this systematic review was therefore to investigate the effect of statin treatment on the occurrence of ischemic and hemorrhagic strokes in patients with a history of cerebrovascular disease.

Methods—We systematically searched the PUBMED database for the combination of the variables "statin" AND "stroke." Furthermore, we searched for relevant studies in the Cochrane Library and Cochrane Central Register of Controlled Trials and handsearched citations. Pooled effect sizes were expressed in relative risk estimates with corresponding 95% CIs.

Results—Four studies were included investigating the effect of statins in 8832 patients with a history of cerebrovascular disease. The pooled relative risk for statin users of overall stroke during follow-up was 0.88 (95% CI: 0.78 to 0.99). The pooled relative risk of ischemic stroke was 0.80 (95% CI: 0.70 to 0.92) and of hemorrhagic stroke 1.73 (95% CI: 1.19 to 2.50).

Conclusion—In patients with a history of cerebrovascular disease, statins clearly decrease the risk of ischemic stroke. However, this beneficial effect is partly lost by an increased risk of hemorrhagic stroke.

Key words: hemorrhagic stroke • ischemic stroke • review • statins

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