http://stroke.ahajournals.org/content/43/10/2677.abstract
Abstract
Background and Purpose—Statins
have been associated with increased risk of intracerebral hemorrhage
(ICH), particularly in elderly patients with
previous ICH. Recurrent ICH in the elderly is
often related to cerebral amyloid angiopathy. Therefore, we
investigated whether
statin use is associated with increased
prevalence and severity of microbleeds (MB), particularly
cortico-subcortical microbleeds
(csMB), which are frequently observed in
cerebral amyloid angiopathy.
Methods—We studied
163 consecutive patients with spontaneous ICH who underwent magnetic
resonance imaging within 30 days of presentation.
We retrieved clinical information and
analyzed magnetic resonance imaging for the presence, location, and
number of MB, which
were divided into csMB or other (other MB).
We performed group comparisons stratified by statin use and by the
presence vs
absence of any MB (csMB and/or other MB) or
csMB alone.
Results—Sixty-four
percent had lobar ICH. Overall, 53% had microbleeds and 39% had csMB.
Statin users were older, had significantly
lower cholesterol and low-density lipoprotein
levels, and higher prevalence of hypertension, diabetes, dyslipidemia,
and antiplatelet
use. The prevalence and number of other MB
were similar in statin-treated and statin-untreated individuals.
However, more
statin-treated patients had csMB (57% vs 33%;
P=0.007), with almost twice as many lesions (4.6±11.3 vs 2.4±8.0; P=0.007) compared with untreated patients. Age and statin use were independently associated with both the presence and increased
number of MB (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00–1.05; P=0.01 and OR, 2.72; 95% CI. 1.02–7.22; P=0.04, respectively) and csMB (OR, 1.03; 95% CI, 1.00–1.06; P=0.01 and OR, 4.15; 95% CI, 1.54–11.20; P<0.01) in multivariate analyses.
Conclusions—Statin
use in patients with ICH is independently associated with MB, especially
csMB. Future studies are needed to confirm
our findings and to investigate whether csMB
can serve as a surrogate marker for ICH risk in statin-treated patients.
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