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Abstract
Objectives: Intracerebral hemorrhage (ICH) is a highly lethal disease of the elderly. Use of statins is increasingly widespread among the elderly, and therefore common in patients who develop ICH. Accumulating data suggests that statins have neuroprotective effects, but their association with ICH outcome has been inconsistent. We therefore performed a meta-analysis of all available evidence, including unpublished data from our own institution, to determine whether statin exposure is protective for patients who develop ICH.
Methods: In our prospectively ascertained cohort, we compared 90-day functional outcome in 238 pre-ICH statin cases and 461 statin-free ICH cases. We then meta-analyzed results from our cohort along with previously published studies using a random effects model, for a total of 698 ICH statin cases and 1,823 non–statin-exposed subjects.
Results: Data from our center demonstrated an association between statin use before ICH and increased probability of favorable outcome (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.37–3.17) and reduced mortality (OR = 0.47, 95% CI 0.32–0.70) at 90 days. No compound-specific statin effect was identified. Meta-analysis of all published evidence confirmed the effect of statin use on good outcome (OR = 1.91, 95% CI 1.38–2.65) and mortality (OR = 0.55, 95% CI 0.42–0.72) after ICH.
Conclusion: Antecedent use of statins prior to ICH is associated with favorable outcome and reduced mortality after ICH. This phenomenon appears to be a class effect of statins. Further studies are required to clarify the biological mechanisms underlying these observations.
Footnotes
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Study funding: Supported by the Deane Institute for Integrative Study of Atrial Fibrillation and Stroke, the NIH/NINDS, and the American Heart Association/Bugher Foundation Centers for Stroke Prevention Research. The funding entities had no involvement in study design, data collection, analysis, or interpretation, writing of the report, or in the decision to submit the paper for publication.
-
- CI=
- confidence interval;
- GCS=
- Glasgow Coma Scale score;
- ICH=
- intracerebral hemorrhage;
- LDL=
- low-density lipoprotein;
- MGH=
- Massachusetts General Hospital;
- mRS=
- modified Rankin Scale;
- OR=
- odds ratio.
-
Supplemental data at www.neurology.org
- Received November 2, 2010.
- Accepted January 19, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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- Statin use and outcome after intracerebral hemorrhage: Case-control study and meta-analysis
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