Statin treatment and intracerebral hemorrhage prognosis

Abstract

Sir, We read with great interest in the study of Tapia-Perez et al. [3] the positive effects of continuous statin treatment on patients after acute intracerebral hemorrhage (ICH). With respect to the delightful effects of statin on acute ICH patients, we have three things in comment. First, although some small sample-sized retrospective observation studies find that continuous statin treatment may have better short-term outcomes in acute ICH patients [2], a larger sample-sized study which analyzes 2,466 consecutive ICH patients finds no association between statin and prognoses or mortality after acute ICH [1]. In fact, the authors also conclude that even though the discontinuation of statin is associated with poor prognoses and higher mortality, the association becomes so weak and no longer significant after excluding patients needing palliative care, who basically have poorer health than other subjects in the study. Therefore, back to the study of Tapia-Perez et al. in discussion, we are curious whether the positive outcomes of statin treatment of the intervention group result from the relatively healthier population in this very group or not, who could tolerate the ordinary medication as well as statin treatment, while the subjects in the non-statin-treated group are basically too ill to stick to the ordinary medication including statin. Second, the values of the study of Tapia-Perez et al. are the consistent measurement and comparison of leucocyte count and C-reactive protein (CRP) level during the trial period. However, it is arbitrary to attribute the effects of better anti-inflammatory to the statin therapy in statintreated group because when comparing with the nonstatin-treated group, the CRP level is only significantly lower in the first 24 h after acute ICH in the statin-treated group, and the physiological outcome does not persist long in day 3 and day 7 after acute ICH. Therefore, there must be some unrecognized factors that affect the physiological outcomes and drug effects, for example, the socioeconomic status, adherence to the post-discharge therapy, and aggressiveness of treatment. However, if the authors can reveal more anthropology information of the study population, it would be much more helpful in determining the influencing factors for physiological outcomes and prognoses. Third, lobar ICH accounts for nearly half (48.2 %) of the statin-treated ICH group in the study of Tapia-Perez et al. [3]. With regard to the statin treatment in lobar ICH patients, one recent study applies decision-analytic approach and suggests that statin should be avoided particularly in lobar ICH patients for its higher risk of recurrent hemorrhage and shorter life expectancy which is estimated at least 2.2 quality-adjusted life-years [4]. The results of no recurrent hemorrhage and decreased mortality at 3 and 6 months in the statin-treated group in the study of Tapia-Perez et al. are somehow impressive. Nevertheless, we suggest that longer follow-up period which exceeded at least 2 years may be necessary for evaluating long-term benefits of statin treatment.