Benefits of statins to prevent stroke outweigh risks

The benefits of lipid-lowering therapy in the prevention of ischaemic stroke greatly exceed the risk of intracerebral haemorrhage (ICH) that may be associated with statins. This conclusion is based on the outcomes of a new meta-analysis of 19 clinical studies [1].

The association between statins and intracerebral haemorrhage risk is still a matter of controversy. A new review and meta-analysis assessed the safety of statins by weighing risks and benefits in terms of cerebral haemorrhagic and ischaemic events. Included were 19 randomised and non-randomised studies with a total of 35,842 patients who had a history of cardiovascular or cerebrovascular events and had been treated with statins. The primary endpoint was ICH; secondary endpoints were ischaemic stroke and transient ischaemic attack (TIA).

The results could not show a significant association between the risk of combined primary and secondary ICH and statin use (RR 1.03; 95% CI 0.85-1.08). However, a sensitivity analysis had a trend toward a higher risk of secondary ICH among those assigned to statin treatment (OR 1.87; 95% CI 0.91-3.86). The risk of stroke and TIA was a significant 21% lower in subjects assigned to statin treatment (RR 0.79; 95% CI 0.61-0.87). Given the considerably higher incidence rates of ischaemic events, the benefit/risk balance of statin treatment is favourable in this patient population. The authors think that the risk of losing the protection against ischaemic events when withdrawing statin use is probably greater than any harm, even in patients with underlying risk factors for ICH.

1. Ishfaq A, et al. Abstract S9.010, AAN 2020.

 



Posted on 9 September 20207 February 2024