Kevin O’Connor, MD

Sprügel MI, Kuramatsu JB, Volbers B, Saam JI, Sembill JA, Gerner ST, Balk S, Hamer HM, Lücking H, Hölter P, et al. Impact of Statins on Hematoma, Edema, Seizures, Vascular Events, and Functional Recovery After Intracerebral Hemorrhage. Stroke. 2021;52:975-984.

Statin use following recent intracerebral hemorrhage (ICH) has been controversial. Sprügel et al. assessed the effects of statins in patients with ICH based on data from a single center in Germany (n=1275).

The statin group was slightly older (median age 76-years, IQR 69–80) than the non-statin group (72 IQR, 61–80). After excluding those receiving oral anticoagulation (228/1275 [17.9%]) and propensity score matching (n=410), among those with ICH, statin use on hospital admission was associated with higher rates of lobar vs. non-lobar hemorrhages (statin, 71/125 [56.8%] versus 130/285 [45.6%]; p=0.037, OR 1.57 [95% CI 1.03–2.40]; p=0.03). There was no difference between groups with regard to ICH volume, incidence of hematoma enlargement, or intraventricular hemorrhage. There was no difference in peak peri-hemorrhagic edema (PHE) related to statin use at admission (statin n=73 versus 293; p=0.853) or statin continuation after admission (continuation n=123 versus 243; p=0.070). Statin initiation, however, was associated with increased peak PHE (initiated n=50 versus 243; p=0.008).

There was no association between statins and having seizures >7 days post ICH and within 12-months (28 patients with statins and 41 patients without [crude incidence: statins: 11.5% versus no statins: 7.8%]) or 5 years (43 patients with statins and 64 patients without [crude incidence: statins: 17.6% versus no statins: 12.2%]). After excluding patients with atrial fibrillation, rates of adverse cardiovascular events were lower in the statin group at 12 months (crude incidence: statins: 11.6% versus no statins: 18.5%; HR, 0.60 [95% CI, 0.36–1.02], p=0.058) and at 5 years (20.9% versus 33.3%; HR, 0.56 [95% CI, 0.38–0.83], p=0.004). Statin use was associated with having functional recovery after 12 months (79/137 [57.7%] versus 103/229 [45.0%]; OR, 1.67 [95% CI, 1.09–2.56], p=0.019).

These data suggest that among patients with ICH, statin use may be associated with a higher risk of lobar compared with deep ICH, but the mechanism for this is unclear. Although statin initiation following ICH was associated with greater peak PHE, statin use at discharge was associated with a reduction in adverse cardiovascular events and better functional recovery after 12 months. Additional research is needed to further explore the effects of statins in the setting of ICH and the impact of statin type or dose.