Risselada Roelof, Straatman Huub, van Kooten Fop, Dippel Diederik W J, van der Lugt Aad, Niessen Wiro J, Firouzian Azadeh, Herings Ron M C, Sturkenboom Miriam C J M
Department of Medical Informatics, Erasmus MC, room Ee 2159, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Stroke. 2009 Aug;40(8):2887-92. doi: 10.1161/STROKEAHA.109.552760. Epub 2009 Jun 11.
Vascular endothelium, which can be affected by statins, is believed to play a substantial role in subarachnoid hemorrhage (SAH). Our objective was to estimate the association between use and withdrawal of statins and the risk of SAH.
We conducted a population-based case-control study within the PHARMO database. A case was defined as a person hospitalized for SAH (ICD-9-CM code 430) in the period January 1, 1998 to December 31, 2006. Ten randomly chosen controls were matched to each case on age, gender, and calendar date.
During the study period 1004 incident cases of SAH were identified. Current use of statins did not significantly decrease the risk of SAH (OR=0.77, 95% CI 0.55 to 1.07). The odds ratio for recent withdrawal compared to nonusers was 1.62 (95% CI 0.96 to 2.73). Compared to current use, recent withdrawal was associated with an increased risk of SAH (OR=2.34, 95% CI 1.35 to 4.05). Interaction analysis showed that the effect of statin withdrawal was highest in patients who had also recently stopped antihypertensive drugs (OR=6.77, 95% CI 2.10 to 21.8).
Current use of statins seems to lower the risk of SAH, although the reduction was not significant in new users. Statin withdrawal increased the risk of SAH by a factor 2, even more in patients who had also recently stopped their antihypertensive treatment.
血管内皮可受他汀类药物影响，其在蛛网膜下腔出血（SAH）中被认为起着重要作用。我们的目的是评估他汀类药物的使用与停用和SAH风险之间的关联。
我们在PHARMO数据库中进行了一项基于人群的病例对照研究。病例定义为在1998年1月1日至2006年12月31日期间因SAH住院的患者（国际疾病分类第九版临床修订本代码430）。为每个病例随机选取10名对照，根据年龄、性别和日历日期进行匹配。
在研究期间，共识别出1004例SAH新发病例。当前使用他汀类药物并未显著降低SAH风险（比值比[OR]=0.77，95%置信区间[CI]为0.55至1.07）。与未使用者相比，近期停用他汀类药物的比值比为1.62（95%CI为0.96至2.73）。与当前使用相比，近期停用与SAH风险增加相关（OR=2.34，95%CI为1.35至4.05）。交互分析表明，在近期也停用了抗高血压药物的患者中，他汀类药物停用的影响最大（OR=6.77，95%CI为2.10至21.8）。
当前使用他汀类药物似乎可降低SAH风险，尽管新使用者的降低幅度不显著。停用他汀类药物使SAH风险增加了2倍，在近期也停用抗高血压治疗的患者中增加得更多。
