Statins Can Boost Brain Hemorrhage Risk After Stroke

"If there is any message that neurologists' will take home from this paper it is that 'I'm going to be a little more pensive about using statins in someone who has presented with a hemorrhage to the brain,'" said Dr. Wade Smith, director of the Neurovascular Service at the University of California, San Francisco.

Smith noted that the most important factor in preventing a second stroke is controlling blood pressure. "We as doctors and as patients need to be very aggressive about making our blood pressures normal after stroke," he said. "That's the most effective way of preventing a second stroke."

Another expert said the doses of Lipitor given in the trial were much higher than most people take.

"It is important to note that most patients on statins are on a much lower dose than that in the SPARCL study," said Dr. Majaz Moonis, director of the stroke prevention clinic at the University of Massachusetts Memorial Medical Center in Worcester. "In our own two independent retrospective study analyses including about 2,500 patients on lower doses of statins, more in line with what patients take, there was no evident increase risk of hemorrhage," he added.

Dr. Eric Smith, associate director of the Acute Stroke Services at Massachusetts General Hospital and Harvard Medical School, thinks statins shouldn't be used in patients who have had a hemorrhagic stroke.

"In my practice, when I see a patient with hemorrhagic stroke, I don't consider that to be an indication for starting a statin, based on the results of this trial," Smith said.

However, for patients who have had a hemorrhagic stroke and are at risk of having a heart attack, Smith does use statins, but at substantially lower doses than were used in SPARCL.

"I start with a low dose and see if that will get cholesterol down to the target level," Smith said. "When I reach the target level, I stop."

More information

For more on stroke, visit the American Stroke Association.

SOURCES: Larry B. Goldstein, M.D., director, Duke Center for Cerebrovascular Disease and Duke Stroke Center, Duke University Medical Center, Durham, N.C.; Wade Smith, M.D., Ph.D., director, Neurovascular Service, and professor, neurology, University of California, San Francisco; Eric Smith, M.D., M.P.H., assistant professor, neurology, and associate director, Acute Stroke Services, Massachusetts General Hospital and Harvard Medical School, Boston; Majaz Moonis, M.D., director, stroke prevention clinic, University of Massachusetts Memorial Medical Center, Worcester; Dec. 12, 2007,Neurologyonline