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Statins May Increase Intracerebral Hemorrhage Volume

Published online by Cambridge University Press:  23 September 2016

Geneviève Ricard ,
Marie-Pierre Garant ,
Nathalie Carrier ,
Nancy Leblanc  and
Jean-Martin Boulanger
Geneviève Ricard
Affiliation:
Centre Hospitalier, Universitaire de Sherbrooke CHUS Department of Neurology, University of Sherbrooke, Sherbrooke, Quebec, Canada
Marie-Pierre Garant
Affiliation:
Étienne-Le Bel Clinical Research Center, Universitaire de Sherbrooke CHUS Centre Hospitalier, Universitaire de Sherbrooke CHUS
Nathalie Carrier
Affiliation:
Étienne-Le Bel Clinical Research Center, Universitaire de Sherbrooke CHUS Centre Hospitalier, Universitaire de Sherbrooke CHUS
Nancy Leblanc
Affiliation:
Hôpital Charles Lemoyne, University of Sherbrooke, Sherbrooke, Quebec, Canada
Jean-Martin Boulanger*
Affiliation:
Department of Neurology, University of Sherbrooke, Sherbrooke, Quebec, Canada Hôpital Charles Lemoyne, University of Sherbrooke, Sherbrooke, Quebec, Canada
*
Neuro Rive-Sud Clinic, 4896 Boulevard Taschereau #250, Greenfield Park, Quebec, J4V 2J2, Canada
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Abstract

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Background:

Some studies have suggested an association between hypocholesterolemia and intracerebral hemorrhage (ICH). In the SPARCL trial, statin use increased ICH risk. We tested the hypothesis that use of statins affects the volume of spontaneous ICH and contributes to the progression of ICH volume between baseline and follow-up CT scans.

Methods:

Consecutive cases of spontaneous ICH were reviewed. Secondary causes were excluded. We measured ICH volume on the baseline and follow-up CT scans using the AxBxC/2 method. Multivariate analysis and logistic regression modeling were used. The primary outcome was the ICH volume on the baseline CT scan. Secondary outcomes included volume variation between the baseline and the first follow up CT scans and death.

Results:

Of 303 subjects, 71 were taking a statin at the time of the ICH (23%). Statin users were significantly more likely to be younger, to have co-morbidities and take anticoagulant or anti-platelet medication. They also had a higher baseline ICH volume than non-statin users (median 31.2 [10,82.1] ml vs 16 [4,43.8] ml; p=0.006). Adjusting for possible confounders, statins remained associated with an increased ICH volume (p=0.007). There was a significant mean ICH volume progression between the first and second CT scans in statin users (+10.8 vs +0.9 ml; p=0.03; 95% CI: [-1,+22.6] [-2.5,+4.3]). No difference in mortality was seen between the two groups.

Conclusion:

Treatment with HMG-CoA reductase inhibitors may be a risk factor for increased ICH volume in spontaneous brain hemorrhages and could contribute to hemorrhage's volume progression.

Résumé

RésuméContexte:

Selon certaines études, il existerait une association entre l'hypocholestérolémie et l'hémorragie intracérébrale (HIC). Dans l'essai clinique SPARCL, l'utilisation d'une statine augmentait le risque d'HIC. Nous avons vérifié l'hypothèse selon laquelle l'utilisation de statines influence le volume de l'HIC spontanée et contribue à la progression du volume de l'HIC à la tomodensitométrie cérébrale initiale et de suivi.

Méthodes:

Des cas consécutifs d'HIC spontanée ont été révisés. Les causes secondaires ont été exclues. Nous avons mesuré le volume de l'HIC à la tomodensitométrie initiale et à celle de suivi au moyen de la formule AxBxC/2. L'analyse multivariée et la régression logistique ont été utilisées pour l'analyse des données. L'issue primaire était le volume de l'HIC à la tomodensitométrie initiale. Les issues secondaires étaient la variation du volume entre la tomodensitométrie initiale et la première effectuée au cours du suivi et le décès.

Résultats:

Soixante et onze des 303 sujets prenaient une statine au moment de l'HIC (23%). Les sujets qui prenaient une statine avaient une plus forte probabilité d'être plus jeunes, d'avoir des comorbidités et de prendre des anticoagulants ou des antiplaquettaires. Ils avaient également un volume initial d'HIC plus grand que ceux qui ne prenaient pas de statines (médiane 31,2 [10,82,1] ml versus 16 [4, 43,8] ml ; p = 0,006). Après ajustement pour les variables confondantes possibles, les statines demeuraient associées à un volume plus grand d'HIC (p = 0,007). Il y avait une progression significative du volume de l'HIC entre la première et la seconde tomodensitométrie chez les sujets qui prenaient une statine (+10,8 versus +0,9 ml ; p = 0,03 ; IC à 95% : -1 à +22,6 et -2,5 à +4,3 respectivement). Nous n'avons pas observé de différence de mortalité entre les deux groupes.

Conclusion:

Le traitement par les inhibiteurs de l'HMG-CoA réductase pourrait constituer un facteur de risque d'un plus grand volume d'HIC dans les hémorragies cérébrales spontanées et pourrait contribuer à la progression du volume de l'hémorragie.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 6 , November 2010 , pp. 791 - 796
Copyright
Copyright © The Canadian Journal of Neurological 2010

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