Journal
NEUROLOGY
Volume 76, Issue 18, Pages 1581-1588Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3182194be9
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Funding
- Deane Institute for Integrative Study of Atrial Fibrillation and Stroke
- NIH/NINDS
- American Heart Association/Bugher Foundation Centers for Stroke Prevention Research
- American Heart Association/Bugher Foundation
- NIH (NINDS, NIA)
- NIH/NIA
- National Stroke Association
- NIH
- CIHR
- Canadian Stroke Network
- Alberta Heritage Fund
- Hotchkiss Brain Institute
- Heart and Stroke Foundation of Canada
- CSL Behring
- Alzheimer's Association
- NIH (NINDS, NHLBI)
- MGH Deane Institute for Integrative Research in Atrial Fibrillation and Stroke
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Objectives: Intracerebral hemorrhage (ICH) is a highly lethal disease of the elderly. Use of statins is increasingly widespread among the elderly, and therefore common in patients who develop ICH. Accumulating data suggests that statins have neuroprotective effects, but their association with ICH outcome has been inconsistent. We therefore performed a meta-analysis of all available evidence, including unpublished data from our own institution, to determine whether statin exposure is protective for patients who develop ICH. Methods: In our prospectively ascertained cohort, we compared 90-day functional outcome in 238 pre-ICH statin cases and 461 statin-free ICH cases. We then meta-analyzed results from our cohort along with previously published studies using a random effects model, for a total of 698 ICH statin cases and 1,823 non-statin-exposed subjects. Results: Data from our center demonstrated an association between statin use before ICH and increased probability of favorable outcome (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.37-3.17) and reduced mortality (OR = 0.47, 95% CI 0.32-0.70) at 90 days. No compound-specific statin effect was identified. Meta-analysis of all published evidence confirmed the effect of statin use on good outcome (OR = 1.91, 95% CI 1.38-2.65) and mortality (OR = 0.55, 95% CI 0.42-0.72) after ICH. Conclusion: Antecedent use of statins prior to ICH is associated with favorable outcome and reduced mortality after ICH. This phenomenon appears to be a class effect of statins. Further studies are required to clarify the biological mechanisms underlying these observations. Neurology (R) 2011;76:1581-1588
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