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Statins could pose dangers for some patients at risk for stroke

Kathleen Blanchard's picture

Statin drugs could cause more harm than good for some patients at risk for stroke according to a Harvard analysis.

Though the medications are used to lower cholesterol and prevent cardiovascular disease and stroke, researchers warn the widely used drugs could be risky for patients with a history of stroke from intracerebral hemorrhage, or bleeding in the brain.

Many patients at risk for brain bleeding that causes stroke are also given statins to reduce co-morbidities from cardiovascular disease, but researchers writing in the Archives of Neurology say widespread use of cholesterol lowering drugs are concerning because of "the increased incidence of intracerebral hemorrhage observed among subjects randomized to statin therapy in a clinical trial of secondary stroke prevention."

M. Brandon Westover, M.D., Ph.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues conducted an analysis of the risk and benefits of statin therapy using a Markov (mathematical) decision model.

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According to Westover, the findings showed patients with a history of intracerebral hemorrhage were found to have an increased risk of intracerebral hemorrhage that increased from 14 percent to approximately 22 percent, "offsetting the cardiovascular benefits for both primary and secondary cardiovascular prevention." The researchers don't know the reasons statin drugs increase the chances of a second stroke from bleeding.

"Our analysis indicates that in settings of high recurrent intracerebral hemorrhage risk, avoiding statin therapy may be preferred," the authors write. They found that in cases of deep intracerebral hemorrhage the risk of recurrence was lower, advising, "...the optimal treatment option may vary with specific circumstances."

Larry B. Goldstein, M.D., of Duke University and Durham VA Medical Center, Durham, N.C writes in an accompanying editorial, "The available data are "generally consistent with the conclusion of the decision analysis—the risk of statin therapy likely outweighs any potential benefit in patients with (at least recent) brain hemorrhage and should generally be avoided in this setting - until and unless there are data to the contrary, or warranted by specific clinical circumstances, the use of statins in patients with hemorrhagic stroke should be guided by the maxim of nonmaleficence—Primum non nocere."

The authors say the decision about prescribing statins for patients with a history of intracerebral hemorrhage is difficult, but without clinical trials that compare dosing of the cholesterol lowering drugs and risk of recurrent brain hemorrhage among the specific types of medications available, the mathematical analysis could be used for clinical guidance.

Arch Neurol: doi:10.1001/archneurol.2010.356

Updated 11/16/2017