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Abstract
Background and Objectives A causal relationship between statin use and intracerebral hemorrhage (ICH) is uncertain. We hypothesized that an association between long-term statin exposure and ICH risk might vary for different ICH locations.
Methods We conducted this analysis using linked Danish nationwide registries. Within the Southern Denmark Region (population 1.2 million), we identified all first-ever cases of ICH between 2009 and 2018 in persons aged ≥55 years. Patients with medical record–verified diagnoses were classified as having a lobar or nonlobar ICH and matched for age, sex, and calendar year to general population controls. We used a nationwide prescription registry to ascertain prior statin and other medication use that we classified for recency, duration, and intensity. Using conditional logistic regression adjusted for potential confounders, we calculated adjusted ORs (aORs) and corresponding 95% CIs for the risk of lobar and nonlobar ICH.
Results We identified 989 patients with lobar ICH (52.2% women, mean age 76.3 years) who we matched to 39,500 controls and 1,175 patients with nonlobar ICH (46.5% women, mean age 75.1 years) who we matched to 46,755 controls. Current statin use was associated with a lower risk of lobar (aOR 0.83; 95% CI, 0.70–0.98) and nonlobar ICH (aOR 0.84; 95% CI, 0.72–0.98). Longer duration of statin use was also associated with a lower risk of lobar (<1 year: aOR 0.89; 95% CI, 0.69–1.14; ≥1 year to <5 years aOR 0.89; 95% CI 0.73–1.09; ≥5 years aOR 0.67; 95% CI, 0.51–0.87; p for trend 0.040) and nonlobar ICH (<1 year: aOR 1.00; 95% CI, 0.80–1.25; ≥1 year to <5 years aOR 0.88; 95% CI 0.73–1.06; ≥5 years aOR 0.62; 95% CI, 0.48–0.80; p for trend <0.001). Estimates stratified by statin intensity were similar to the main estimates for low-medium intensity therapy (lobar aOR 0.82; nonlobar aOR 0.84); the association with high-intensity therapy was neutral.
Discussion We found that statin use was associated with a lower risk of ICH, particularly with longer treatment duration. This association did not vary by hematoma location.
Glossary
- aOR=
- adjusted OR;
- CAA=
- cerebral amyloid angiopathy;
- ICH=
- intracerebral hemorrhage;
- IVH=
- intraventricular hemorrhage;
- RSD=
- Region of Southern Denmark;
- SVD=
- small vessel disease
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil, FAAN.
CME Course: NPub.org/cmelist
- Received August 29, 2022.
- Accepted in final form October 24, 2022.
- © 2022 American Academy of Neurology
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- Reader Response: Association Between Statin Use and Intracerebral Hemorrhage Location: A Nested Case-Control Registry Study
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