Statins May Be Harmful After Stroke01/10/11
MONDAY, Jan. 10 (HealthDay News) -- Patients given
cholesterol-lowering drugs called statins after suffering a stroke
caused by bleeding in the brain may be at an increased risk of
having another such stroke, a new study suggests.
It is well-known that statins help reduce the risk of heart
disease and ischemic stroke, where a clot blocks a blood vessel in
the brain. However, whether statins also benefit patients who have
had a hemorrhagic (bleeding) stroke is unclear.
Lead researcher Dr. Steven M. Greenberg, director of the
Hemorrhagic Stroke Research Program at Massachusetts General
Hospital in Boston, said that "there is a group of patients who
have to think carefully about whether they are getting benefit from
being on a statin. Those are people who have had a hemorrhagic
stroke and survived it and are trying to figure out how to prevent
"For some of those people, the risk of being on the medication may be greater than the risk of not being on it," Greenberg said.
However, a lot depends on the location of the stroke in the
brain, added lead study author Dr. M. Brandon Westover, a neurology
resident at Massachusetts General.
"In one case [bleeding in the cerebrum] our answer was pretty clear-cut -- you shouldn't be on those medicines," he said.
"But for hemorrhages deep in the brain, usually caused by long-term high blood pressure, the risk of a new hemorrhage is lower, so our results were less clear-cut," he said. "But you are probably a little better off not being on the medication in that case, too."
The report is published in the Jan. 10 online edition of the
Archives of Neurology.
For the study, Westover and his colleagues used a computer
program called a Markov decision model to figure out whether
statins were a benefit or risk to patients after a hemorrhagic
Using this model, they were able to simulate patient's
conditions to show combinations of events that could lead to the
increased risk of stroke or heart disease, change in quality of
life, or death.
The results of their study indicated that patients taking
statins had a 14 percent to 22 percent greater risk of having
another hemorrhagic stroke, particularly patients whose stroke was
a lobar intracerebral hemorrhage, or bleeding in the part of the
brain called the cerebrum.
For these patients, the risk of taking a statin outweighed any
benefit from the drug, the researchers found.
"However, the last word isn't in on how consistently statins increase the risk for a second hemorrhagic stroke," Greenberg said. "But there is at least enough now to make it something to be discussed between patient and doctor."
For patients whose bleeding occurred deep within the brain, the
benefit versus the risk of statins was more balanced, they noted.
This suggests that whether or not to prescribe a statin after
hemorrhagic stroke may depend on the location of the stroke in the
Why statins might increase the risk of hemorrhagic stroke is
unknown, Westover said. It may be due to an increased risk of brain
bleeding among people with low cholesterol, or perhaps statins
prevent clotting, he said.
Greenberg noted that the use of statins to prevent a second
ischemic stroke, one caused by a clot in a blood vessel in the
brain, is standard care and has been shown to be effective.
Dr. Larry B. Goldstein, director of the Duke Stroke Center and
author of an accompanying journal editorial, said the current data
on the use of statins after a hemorrhagic stroke is limited but he
generally supports this latest finding.
Dr. Ralph L. Sacco, president of the American Heart Association
and chairman of neurology at the University of Miami Miller School
of Medicine, said that the recent guidelines from the American
Heart Association recommend statins after ischemic stroke.
"We believe that people with a lobar hemorrhage are at greater risk of bleeding from a variety of drugs, possibility including statins," he said. "It is not routine that we would start a statin after intracerebral hemorrhage."
For more information on hemorrhagic stroke, visit the
American Stroke Association.
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