Statins Can Boost Brain Hemorrhage Risk After Stroke

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By Steven Reinberg
HealthDay Reporter
Wednesday, December 12, 2007; 12:00 AM

WEDNESDAY, Dec. 12 (HealthDay News) -- Some people taking statins after a stroke might face an increased risk of having a brain hemorrhage, a new study suggests.

But the risk of this life-threatening condition needs to be balanced against the benefit of statins in lowering the overall risk of a second stroke and heart attack, experts stress.

"There is a small but significant increased risk of brain hemorrhage among people who have had a previous stroke who take Lipitor, especially among those who have had a previous brain hemorrhage," said lead researcher Dr. Larry B. Goldstein, director of the Duke Center for Cerebrovascular Disease and the Duke Stroke Center at Duke University Medical Center. "If you don't have a history of stroke, then none of this matters."

Based on these findings, patients who have had a hemorrhagic stroke should not receive a statin to lower cholesterol, Goldstein said. "Having had a brain hemorrhage within the prior one to six months, one should be very cautious about starting a patient on a statin," he noted.

The report is published in the Dec. 12 online edition ofNeurology.

In the study, Goldstein's group analyzed data from the Stroke Prevention with Aggressive Reduction in Cholesterol Levels (SPARCL) trial. In SPARCL, 4,731 people received 80 milligrams of Lipitor daily or placebo.

All those in the trial had had a stroke or a transient ischemic attack (TIA) one to six months before entering the SPARCL trial. None of the participants had a history of heart disease.

During an average of 4.5 years of follow-up, people taking Lipitor had a 16 percent reduction in second strokes and significant reductions in heart attacks. However, further analysis found an increase in the risk of brain hemorrhage.

Among those taking Lipitor, 2.3 percent had a hemorrhagic stroke compared with 1.4 percent of those taking placebo. On the plus side, there was a 21 percent reduction in ischemic stroke, the most common type of stroke, among those taking Lipitor, Goldstein noted.

Other factors that increased the risk of brain hemorrhage included being older, having had a previous hemorrhagic stroke, being male and having high blood pressure. In fact, people with severe high blood pressure had more than six times the risk of hemorrhagic stroke compared with people with normal blood pressure.

For most patients, statins such as Lipitor do help prevent strokes and heart attacks, Goldstein said. "For patients who have not had a stroke or TIA within the past six months -- there is no risk of hemorrhage," he said.

One expert agreed that patients who have had a hemorrhagic stroke should probably not be given statins.


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