Public Release: 

Statins associated with better outcomes in hospitalization for brain hemorrhage

The JAMA Network Journals

Bottom Line: Hospitalized patients who took statins after a stroke caused by an intracerebral hemorrhage (ICH, bleeding in the brain) appeared to have better 30-day survival and were more likely to be discharged to their home or an acute rehabilitation facility than patients who did not use statins or whose statin use was discontinued in the hospital.

Author: Alexander C. Flint, M.D., Ph.D., of Kaiser Permanente Northern California, Redwood City, Calif., and colleagues.

Background: Statins are known to reduce the risk of ischemic stroke among patients with a history of ischemic stroke. Ischemic stroke and hemorrhagic stroke (ICH) have different primary causes but share many molecular causes for the secondary brain injury that may be influenced by statins.

How the Study Was Conducted: The authors examined the effect of inpatient statin use and the stopping of statin use in a group of 3,481 patients with ICH admitted to 20 hospitals in a large health care system over a 10-year period. They analyzed electronic medical and pharmacy records.

Results: Of the 2,321 patients not using a statin as an outpatient before ICH, 425 (18.3 percent) received a statin as an inpatient. And, of the 1,160 patients who used a statin as an outpatient, 391 (33.7 percent) did not receive statins as an inpatient. Inpatient statin users had a 30-day unadjusted mortality rate of 18.4 percent compared with 38.7 percent for patients not treated with statins. Patients treated with a statin during hospitalization for ICH were discharged to home or a rehabilitation facility 51.1 percent of the time compared with 35 percent of the time for patients not treated with statins. Patients whose statin therapy was discontinued as an inpatient had an unadjusted mortality rate of 57.8 percent compared with 18.9 percent for patients using a statin before and during hospitalization. Patients whose statin therapy was discontinued were discharged to home or inpatient rehabilitation 22.3 percent of the time compared with 49.8 percent of the time for patients who used a statin before and during hospitalization.

Discussion: "Statin use is associated with improved outcomes after ICH, and the cessation of statin use is associated with worsened outcomes after ICH. ... The particular association between cessation of statin use and worsened outcomes merits careful consideration of the risk-benefit balance of discontinuing statin therapy in the acute setting of ICH."

(JAMA Neurol. Published online September 22, 2014. doi:10.1001/.jamaneurol.2014.2124. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Conflict of interest disclosures were made. The present study was supported by a Community Benefit grant from the Kaiser Foundation Research Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Statin Use and Brain Hemorrhage

In a related editorial, Marco A. Gonzalez-Castellon, M.D., and Randolph S. Marshall, M.D., M.S., of Columbia University Medical Center, New York, write: "Despite physiological and clinical evidence on both sides of the argument, the idea that statins should be avoided whenever brain hemorrhage is involved has permeated stroke practice."

"New evidence on the positive effects of statins in spontaneous ICH appears in this issue of JAMA Neurology. Flint and colleagues demonstrate that statin use during the acute period after ICH was not associated with increased hemorrhage risk but was strongly associated with improved outcomes at 30 days," they continue.

"The controversy regarding statin use and ICH is far from settled. ... Their study thus requires validation in a prospective cohort. For now, however, it provides sufficient evidence to recommend at least the continuation of statin therapy after nonamyloid ICH for at least 30 days after the initial event. Further study of this important management question is warranted," they conclude.

(JAMA Neurol. Published online September 22, 2014. doi:10.1001/.jamaneurol.2014.2463. Available pre-embargo to the media at http://media.jamanetwork.com.)

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Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact author Alexander C. Flint, M.D., Ph.D., call Janet Byron at 510-891-3115 or email Janet.L.Byron@kp.org. To contact editorial corresponding author Randolph S. Marshall, M.D., call Karin Eskenazi at 212-342-0508 or email ket2116@cumc.columbia.edu

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