Statin Use Following Intracerebral Hemorrhage

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Abstract
Although the benefits of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) for reducing risk of cardiac and cerebrovascular disease are well established,1,2 more widespread use of statin therapy remains controversial. A particular subgroup of patients for whom the advisability of statin use is unclear are those at high risk for intracerebral hemorrhage (ICH).3 The reason for added concern is the increased incidence of ICH observed among subjects randomized to statin therapy in a clinical trial of secondary stroke prevention.2,4 This risk amplification might have greatest relevance to patients at high risk for hemorrhage by virtue of prior ICH, particularly hemorrhages in lobar brain regions characteristic of the degenerative vascular condition cerebral amyloid angiopathy.5,6 Because ICH survivors commonly have comorbid cardiovascular risk factors that would otherwise warrant cholesterol-lowering medication, it is important to weigh the risks and benefits of statin therapy in this population.