Prior Statin Use Has No Effect on Survival After Intracerebral Hemorrhage in a Multiethnic Asian Patient Cohort
Background: Statins have been shown to reduce mortality and morbidity in ischemic stroke, subarachnoid hemorrhage, and traumatic brain injuries, but their effect on intracerebral hemorrhage (ICH) remains to be determined. This study aimed to investigate t
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Abstract Background: Statins have been shown to reduce mortality and morbidity in ischemic stroke, subarachnoid hemorrhage, and traumatic brain injuries, but their effect on intracerebral hemorrhage (ICH) remains to be determined. This study aimed to investigate the effect of prior statin use on survival following spontaneous primary intracerebral hemorrhage in a multi-ethnic Asian population. Subjects and Methods: A study cohort of patients admitted with spontaneous primary ICH was obtained from our database. There were 1,381 patients who met the inclusion criteria. Multivariate logistic regression was used to identify independent predictors and computed odds ratios for 30-day mortality. Kaplan–Meier and Cox proportional hazard survival analyses were used to examine the effect of prior statin use on survival after ICH. Results: Multivariate logistic regression controlling for baseline characteristics and in-hospital interventions, did not demonstrate any effect of prior statin use (p = 0.781) on mortality. Survival analyses also failed to demonstrate any differences in survival after ICH with prior statin use. Similarly subgroup analyses showed no difference. Conclusion: No beneficial effect on survival after ICH of prior statin use could be demonstrated in our large multiethnic Asian patient cohort. Keywords Intracerebral hemorrhage • Hemorrhagic stroke • Statin • Mortality
N.K.K. King and B.-T. Ang () Department of Neurosurgery, National Neuroscience Institute Singapore, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore e-mail: [email protected] V.K.-S. Tay and J.C. Allen Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, 169857 Singapore
Introduction Intracerebral hemorrhage (ICH) is a type of stroke that has been associated with high morbidity and mortality. Despite on-going advances, the case fatality from ICH has not improved worldwide since the 1980s. Its incidence in Asia is about twice that of the rest of the world and represents a significant burden on medical resources and on society [13]. The difference in incidence appears to be multifactorial with differences attributed to different risk profiles, genetics, and other undetermined factors governing the outcomes of ICH experienced amongst Asians compared with the western population [4, 13]. The HMG-CoA reductase inhibitors, also known as statins, have been demonstrated to be beneficial in ischemic stroke [1, 8], subarachnoid hemorrhage, and traumatic brain injury [12]. As such, the effect of prior use of statins on survival after ICH has generated much interest. In addition to its known lipid-lowering effects, statins have been purported to have neuroprotective properties [2, 14]. It is these properties that may prove to be effective in improving the sequelae of ICH. However, with different studies showing varying effect on hematoma expansion [3], peri-hematoma edema [10], mortality [3, 5, 9, 11], and functional outcome [3, 5, 6, 9], the overall beneficial effect on statin use in ICH remains to be determined.
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