Statins and Intracerebral Hemorrhage A Retrospective Cohort Study

Background: A recent post hoc analysis of a large randomized trial in patients with cerebrovascular disease suggested that statins may increase the risk of intracerebral hemorrhage (ICH). Objective: To examine the association between statins and ICH in patients with recent ischemic stroke in a population-based setting. Design: Retrospective propensity-matched cohort study with accrual from July 1, 1994, to March 31, 2008. Setting: Ontario, Canada. Participants: A total of 17 872 patients aged 66 years and older who initiated statin therapy following acute ischemic stroke and were followed for a median of 4.2 years (interquartile range, 2.4-5.0 years). To enhance causal inference, we conducted several tests of specificity to exclude healthy user bias in this sample. Main Outcome Measure: Hospitalization or emergency department visit for ICH defined using validated diagnosis coding. Results: Overall, 213 episodes of ICH occurred. In the primary analysis comparing statin users with nonusers, we found no association between statins and ICH (hazard ratio=0.87; 95% confidence interval, 0.65-1.17). Subgroup and dose-response analyses yielded similar results. In tests of specificity, statin therapy was not associated with bone mineral density testing, vitamin D or B-12 screening, gastrointestinal endoscopy, or elective knee arthroplasty, suggesting that results were not due to healthy user bias or differences in quality of care. Conclusion: Statin exposure following ischemic stroke was not associated with ICH.