Statin Therapy Should Not be Discontinued in Patients With Intracerebral Hemorrhage

Abstract

The case under question reports spontaneous cerebellar hemorrhage in a 72-year-old man with a history of hypertension, lacunar stroke, and mild cognitive impairment. In the natural history of small vessel disease, the likely pathological situation causing this case, ischemic and hemorrhagic events, represents different expressions of the same underlying microangiopathy. These 2 phenotypes may require different therapeutic approaches. The concern in this patient, on statin therapy for ischemic stroke prevention, is that he now has an intracerebral hemorrhage (ICH). So, what should we do with statins when brain ischemia and hemorrhage are both on board? Several years ago, neurologists feared this situation, and withdrawal was the main approach taken. At that time, we were probably influenced by the side effects observed in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial (high-dose statins increasing the risk of hemorrhagic stroke) and concerned about the association between low-density lipoprotein level and hemorrhagic stroke, claimed by many authors. However, changes are coming, and new evidence supports the notion that maintaining our …