Statins lower risk of recurrent stroke

Statins lower risk of recurrent stroke

Taking Statins After an Intracerebral Hemorrhage: New Study Reveals Positive Findings

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According to a recent study, individuals who have experienced an intracerebral hemorrhage, a type of bleeding stroke, may benefit from taking statins. These findings provide reassurance, stating that statin use does not increase the risk of subsequent intracerebral hemorrhages. Furthermore, statins have been shown to reduce the risk of ischemic stroke after an intracerebral hemorrhage.

Ischemic strokes, caused by a blockage in an artery or blood vessel in the brain, are the most common type of stroke, affecting approximately 87% of stroke patients. On the other hand, bleeding strokes, including intracerebral hemorrhages and subarachnoid hemorrhages, account for about 13% of strokes, with intracerebral hemorrhages being more prevalent.

Intracerebral hemorrhages are particularly dangerous, with an estimated incidence of 10 to 25 cases per 100,000 individuals worldwide. Unfortunately, the 30-day survival rate for this type of stroke has not significantly improved in the past two decades. This study aimed to explore the impact of statin use in individuals who had survived a first bleeding stroke.

The study observed 15,151 people from Denmark who had experienced a first bleeding stroke and survived for at least 30 days. The researchers closely monitored this group until they either had another stroke, emigrated, passed away, or until the study concluded. Analyzing prescription data allowed the researchers to differentiate between individuals who took statins and those who did not after their stroke.

Through a nested analysis, the researchers compared different subgroups within the study population, including individuals who had any kind of stroke, those with intracerebral hemorrhages, and those with recurring intracerebral hemorrhages. They concluded that statin use was associated with a 21% lower risk of an ischemic stroke after a first intracerebral hemorrhage, without affecting the risk of recurrence.

These findings provide valuable insights, highlighting the potential benefits of statin therapy for individuals who have already experienced an intracerebral hemorrhage. While statins are commonly prescribed for high cholesterol, their pleiotropic effects, such as anti-inflammatory properties, have been increasingly recognized. High-intensity statin therapy has already been established as beneficial for individuals with acute ischemic stroke, according to randomized clinical trials.

Dr. Sandra Narayanan, a vascular neurologist and neuro-interventional surgeon at the Pacific Stroke & Neurovascular Center, emphasizes the growing number of people with high cholesterol who could benefit from statin therapy. She explains that these drugs not only lower cholesterol but also have various anti-inflammatory effects at the cellular level, benefiting multiple organ systems.

Despite the positive findings, concerns were previously raised regarding the use of statins in patients with a history of intracerebral hemorrhage. Some trials suggested a higher risk of recurrent hemorrhage, particularly when the lipid levels were significantly lowered. Dr. Narayanan stresses the importance of managing comorbid conditions that require statin therapy in these patients, as discontinuing statins solely due to concerns of recurrent intracranial hemorrhage poses a medical management dilemma.

This study contributes to addressing this particular concern, as it found no additional risk of recurrent intracerebral hemorrhage in individuals who had already experienced one. It further assures that the ratio of cases to control within each subgroup is comforting, underscoring the reliability of the results. However, further randomized research is needed to validate and confirm these findings.

Dr. Narayanan also discusses some of the causes of intracerebral hemorrhages. She highlights that populations such as Asian individuals may have a higher risk, along with specific risk factors like male gender, older age, and other diseases or vasculopathies affecting the intracranial arteries. Conditions like “moyamoya disease,” which narrows the large arteries of the brain, can lead to both ischemic and hemorrhagic strokes. As patients age, cerebral amyloid and angiopathy become more common causes.

In addition, Dr. Narayanan sheds light on various risk factors for intracerebral hemorrhages, including lifestyle factors that can impact macro and microvascular changes. Factors such as tobacco and alcohol abuse, as well as the use of substances that activate the sympathetic nervous system (e.g., cocaine, amphetamines, cannabis, and heroin), have been associated with an increased risk.

High blood pressure plays a significant role in both ischemic and intracerebral strokes. Dr. Narayanan explains that hypertension can cause injury to the arteries in the brain, as well as other organs like the kidneys, leading to long-term effects on vessel elasticity, thinning, and friability. Effective blood pressure control is crucial in lowering the risk of recurrent strokes, highlighting the importance of blood pressure-lowering therapy.

Overall, this study provides encouraging news for individuals who have experienced an intracerebral hemorrhage. It reveals the positive effects of statins in reducing the risk of ischemic stroke without increasing the risk of recurrence. With growing evidence on the pleiotropic effects of statins and their benefits in various conditions, the potential of these drugs continues to be unlocked. While further research is necessary to affirm these findings, this study imparts optimism for individuals seeking effective stroke prevention strategies.