BACKGROUND AND PURPOSE: The impact of statins on hematoma characteristics, perihemorrhagic edema (PHE), cardiovascular events, seizures, and functional recovery in patients with intracerebral hemorrhage (ICH) is insufficiently studied. METHODS: Patients with ICH of the prospective UKER-ICH (Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage) study (URL: https://www.clinicaltrials.gov; Unique identifier: NCT03183167) were analyzed by multivariable regression modeling and propensity score matching, and PHE volumes were volumetrically assessed. Outcomes comprised hematoma characteristics, the impact of continuation, discontinuation, and initiation of statins on peak PHE extent, and the influence of statin treatment on the occurrence of seizures, cardiovascular adverse events, and functional recovery after ICH. RESULTS: A total of 1275 patients with ICH with information on statin treatment were analyzed. Statin treatment on hospital admission (21.7%) was associated with higher rates of lobar versus nonlobar ICH (odds ratio, 1.57 [1.03-2.40]; P=0.038). Initiation of statins after ICH was associated with increased peak PHE (β=0.12, SE=0.06, P=0.008), whereas continuation versus discontinuation of prior statin treatment was not significantly associated with edema formation (P>0.10). There were no significant differences in the incidence of remote symptomatic seizures according to statin exposure during follow-up (statins: 11.5% versus no statins: 7.8%, subdistribution hazard ratio: 1.15 [0.80-1.66]; P=0.512). Patients on statins revealed less cardiovascular adverse events and more frequently functional recovery after 12 months (functional recovery: 57.7% versus 45.0%, odds ratio 1.67 [1.09-2.56]; P=0.019). CONCLUSIONS: Among statin users, lobar ICH occurs more frequently as compared with nonstatin users. While continuation of prior statin treatment appears to be safe regarding PHE formation, the initiation of statins during the first days after ICH may increase PHE extent. However, statins should be initiated thereafter (eg, at hospital discharge) to prevent cardiovascular events and potentially improve functional recovery.
BACKGROUND AND PURPOSE: The impact of statins on hematoma characteristics, perihemorrhagic edema (PHE), cardiovascular events, seizures, and functional recovery in patients with intracerebral hemorrhage (ICH) is insufficiently studied. METHODS: Patients with ICH of the prospective UKER-ICH (Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage) study (URL: https://www.clinicaltrials.gov; Unique identifier: NCT03183167) were analyzed by multivariable regression modeling and propensity score matching, and PHE volumes were volumetrically assessed. Outcomes comprised hematoma characteristics, the impact of continuation, discontinuation, and initiation of statins on peak PHE extent, and the influence of statin treatment on the occurrence of seizures, cardiovascular adverse events, and functional recovery after ICH. RESULTS: A total of 1275 patients with ICH with information on statin treatment were analyzed. Statin treatment on hospital admission (21.7%) was associated with higher rates of lobar versus nonlobar ICH (odds ratio, 1.57 [1.03-2.40]; P=0.038). Initiation of statins after ICH was associated with increased peak PHE (β=0.12, SE=0.06, P=0.008), whereas continuation versus discontinuation of prior statin treatment was not significantly associated with edema formation (P>0.10). There were no significant differences in the incidence of remote symptomatic seizures according to statin exposure during follow-up (statins: 11.5% versus no statins: 7.8%, subdistribution hazard ratio: 1.15 [0.80-1.66]; P=0.512). Patients on statins revealed less cardiovascular adverse events and more frequently functional recovery after 12 months (functional recovery: 57.7% versus 45.0%, odds ratio 1.67 [1.09-2.56]; P=0.019). CONCLUSIONS: Among statin users, lobar ICH occurs more frequently as compared with nonstatin users. While continuation of prior statin treatment appears to be safe regarding PHE formation, the initiation of statins during the first days after ICH may increase PHE extent. However, statins should be initiated thereafter (eg, at hospital discharge) to prevent cardiovascular events and potentially improve functional recovery.
Authors: Joji B Kuramatsu; Stefan T Gerner; Wendy Ziai; Stefan Schwab; Daniel F Hanley; Hagen B Huttner; Jürgen Bardutzky; Jochen A Sembill; Maximilian I Sprügel; Anne Mrochen; Kathrin Kölbl; Malathi Ram; Radhika Avadhani; Guido J Falcone; Magdy H Selim; Vasileios-Arsenios Lioutas; Matthias Endres; Sarah Zweynert; Peter Vajkoczy; Peter A Ringleb; Jan C Purrucker; Jens Volkmann; Hermann Neugebauer; Frank Erbguth; Peter D Schellinger; Ulrich J Knappe; Gereon R Fink; Christian Dohmen; Jens Minnerup; Heinz Reichmann; Hauke Schneider; Joachim Röther; Gernot Reimann; Michael Schwarz; Hansjörg Bäzner; Joseph Claßen; Dominik Michalski; Otto W Witte; Albrecht Günther; Gerhard F Hamann; Hannes Lücking; Arnd Dörfler; Muhammad Fawad Ishfaq; Jason J Chang; Fernando D Testai; Daniel Woo; Andrei V Alexandrov; Dimitre Staykov; Nitin Goyal; Georgios Tsivgoulis; Kevin N Sheth; Issam A Awad Journal: Stroke Date: 2022-05-06 Impact factor: 10.170
Authors: Lena Rühl; Joji B Kuramatsu; Jochen A Sembill; Bernd Kallmünzer; Dominik Madzar; Stefan T Gerner; Antje Giede-Jeppe; Stefanie Balk; Tamara Mueller; Jakob Jäger; Stefan Schwab; Hagen B Huttner; Maximilian I Sprügel Journal: J Neurol Neurosurg Psychiatry Date: 2022-01-27 Impact factor: 13.654
Authors: David Haupenthal; Joji B Kuramatsu; Bastian Volbers; Jochen A Sembill; Anne Mrochen; Stefanie Balk; Philip Hoelter; Hannes Lücking; Tobias Engelhorn; Arnd Dörfler; Stefan Schwab; Hagen B Huttner; Maximilian I Sprügel Journal: JAMA Netw Open Date: 2021-07-01