Statin risks may outweigh benefits for patients with a history of brain hemorrhage

Jan 10, 2011

A computer decision model suggests that for patients with a history of bleeding within the brain, the risk of recurrence associated with statin treatment may outweigh the benefit of the drug in preventing cardiovascular disease, according to a report posted online today that will appear in the May print issue of Archives of Neurology.

The benefits of for reducing the risk of heart disease and are well established, but more widespread use of statin therapy remains controversial, according to background information in the article. "A particular subgroup of patients for whom the advisability of statin use is unclear are those at high risk for intracerebral ," or a stroke caused by bleeding within the brain, the authors write. "The reason for added concern is the increased incidence of intracerebral hemorrhage observed among subjects randomized to statin therapy in a clinical trial of secondary ."

"Because intracerebral hemorrhage sufferers commonly have co-morbid [co-occurring] that would otherwise warrant cholesterol-lowering medication, it is important to weigh the risks and benefits of statin therapy in this population," write M. Brandon Westover, M.D., Ph.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues. The researchers used a Markov decision model to evaluate these benefits and risks. Based on prior research, simulated patients were assigned to states that correspond to disease risk and could then experience any combination of events which may lead to the increased risk of stroke or , change in quality of life or death.

"Our analysis indicates that in settings of high recurrent intracerebral hemorrhage risk, avoiding statin therapy may be preferred," the authors write. "For lobar intracerebral hemorrhage [bleeding in the cerebrum] in particular, which has a substantially higher recurrence rate than does deep intracerebral hemorrhage, statin therapy is predicted to increase the baseline annual probability of recurrence from approximately 14 percent to approximately 22 percent, offsetting the cardiovascular benefits for both primary and secondary cardiovascular prevention."

In the case of deep intracerebral hemorrhage, a type of stroke due to bleeding deep within the brain that has a lower risk of recurrence, the benefits and risks of statin use were more evenly balanced. "Consequently, the optimal treatment option may vary with specific circumstances," the authors write.

The mechanism by which statins might increase the risk of hemorrhagic stroke are unknown, the authors note. The association may be due to an increased risk of brain bleeding among those with lower cholesterol levels, or potential anti-clotting properties of statins.

"In summary, mathematical decision analysis of the available data suggests that, because of the high risk of recurrent intracerebral hemorrhage in survivors of prior hemorrhagic stroke, even a small amplification of this risk by use of statins suffices to recommend that they should be avoided after intracerebral hemorrhage," the authors conclude. "In the absence of data from a randomized clinical trial (ideally comparing various agents and doses), the current model provides some guidance for clinicians facing this difficult decision."

Explore further: New viral tools for mapping brains

More information: Arch Neurol. Published online January 10, 2011. doi:10.1001/archneurol.2010.356

add to favorites email to friend print save as pdf

Related Stories

Cholesterol-lowering drugs and the risk of hemorrhagic stroke

Dec 12, 2007

People taking cholesterol-lowering drugs such as atorvastatin after a stroke may be at an increased risk of hemorrhagic stroke, or bleeding in the brain, a risk not found in patients taking statins who have never had a stroke. ...

Blood-Thinning Drug Linked to Increased Bleeding in Brain

Sep 29, 2008

(PhysOrg.com) -- Patients who take the commonly used blood-thinning drug warfarin face larger amounts of bleeding in the brain and increased risk of mortality if they suffer a hemorrhagic stroke, new research from the University ...

Recommended for you

New viral tools for mapping brains

1 hour ago

(Medical Xpress)—A brain-computer-interphase that is optogenetically-enabled is one of the most fantastic technologies we might envision today. It is likely that its full power could only be realized under ...

Link seen between seizures and migraines in the brain

17 hours ago

Seizures and migraines have always been considered separate physiological events in the brain, but now a team of engineers and neuroscientists looking at the brain from a physics viewpoint discovered a link ...

Neuroscience: Why scratching makes you itch more

23 hours ago

Turns out your mom was right: Scratching an itch only makes it worse. New research from scientists at Washington University School of Medicine in St. Louis indicates that scratching causes the brain to release ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

rwinners
not rated yet Jan 11, 2011
Is there a point in life where taking 'preventive' drugs such as statins, and even the ubiquitous daily aspirin becomes more of a risk than a benefit?

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.