Statins May Increase Intracerebral Hemorrhage Volume

Abstract

Some studies have suggested an association between hypocholesterolemia and intracerebral hemorrhage (ICH). In the SPARCL trial, statin use increased ICH risk. We tested the hypothesis that use of statins affects the volume of spontaneous ICH and contributes to the progression of ICH volume between baseline and follow-up CT scans. Consecutive cases of spontaneous ICH were reviewed. Secondary causes were excluded. We measured ICH volume on the baseline and follow-up CT scans using the AxBxC/2 method. Multivariate analysis and logistic regression modeling were used. The primary outcome was the ICH volume on the baseline CT scan. Secondary outcomes included volume variation between the baseline and the first follow up CT scans and death. Of 303 subjects, 71 were taking a statin at the time of the ICH (23%). Statin users were significantly more likely to be younger, to have co-morbidities and take anticoagulant or anti-platelet medication. They also had a higher baseline ICH volume than non-statin users (median 31.2 [10, 82.1] ml vs 16 [4, 43.8] ml; p=0.006). Adjusting for possible confounders, statins remained associated with an increased ICH volume (p=0.007). There was a significant mean ICH volume progression between the first and second CT scans in statin users (+10.8 vs +0.9 ml; p=0.03; 95% CI: [-1, +22.6] [-2.5, +4.3]). No difference in mortality was seen between the two groups. Treatment with HMG-CoA reductase inhibitors may be a risk factor for increased ICH volume in spontaneous brain hemorrhages and could contribute to hemorrhage's volume progression.