Background:
The safety of statin use in patients with intracerebral hemorrhage (ICH) is an unsettled issue of critical importance during stroke management. To assess the benefits and risks of statin use in ICH patients, we analyzed the big data from the Taiwan National Health Insurance Research Database (NHIRD) collected from a population known to have a higher ICH incidence than the Westerners.
Methods and Results:
A random sample of 1,000,000 subjects representative of the 23-million population registered in the NHIRD from 1997 to 2010 was used for this retrospective cohort study. The cumulative risks of ICH, ischemic stroke, and transient ischemic attack (TIA) were analyzed among three ICH cohorts: non-statin (NS; no statin use before or after ICH), statin (S; continued or initiated statin use after ICH), and statin-withdrawal (SW; statin use discontinued after ICH). A total of 2408 ICH patients (age 63.4±14.2 years, 62.5% male) were identified between 2000 and 2005 and followed for an average of 7.0 years. A Cox proportional hazard regression model was applied to estimate the hazard ratios (HRs) with adjustment for potential confounders. Compared to NS, S had a 71% (HR 0.29, CI 0.19-0.43; P<0.001) reduction in ICH recurrence (Figure). The risk of ICH recurrence decreased as a function of the increment of cumulative defined daily doses (P trend <0.0001). In contrast, SW had a 1.5-fold increase in ICH recurrence (HR 1.55, CI 1.09-2.22; P=0.016) and a 2-fold increase in ischemic stroke or TIA development (HR 2.01,CI 1.30-3.11; P=0.002).
Conclusions:
Based on this large database, continuation or initiation of stain use in ICH patients is associated with a reduced risk of ICH recurrence in a dose-dependent manner; discontinuation of statin use confers significant risks for both ICH recurrence and ischemic stroke/TIA development. Mechanistic studies are warranted to further validate the significance of this observation.
Statin use and the reoperation rates in glaucoma filtration surgery – population‐based cohort study
