Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL, London, UK.
The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
J Neurol Neurosurg Psychiatry. 2019 Jan;90(1):75-83. doi: 10.1136/jnnp-2018-318483. Epub 2018 Aug 27.
Whether statins increase the risk of intracerebral haemorrhage (ICH) in patients with a previous stroke remains uncertain. This study addresses the evidence of statin therapy on ICH and other clinical outcomes in patients with previous ischaemic stroke (IS) or ICH.
A systematic literature review and meta-analysis was performed in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess observational and randomised studies comparing statin therapy with control (placebo or no treatment) in patients with a previous ICH or IS. The risk ratios (RR) for the primary outcome (ICH) and secondary outcomes (IS, any stroke, mortality and function) were pooled using random effects meta-analysis according to stroke subtype.
Forty-three studies with a combined total of 317 291 patient-years of follow-up were included. In patients with previous ICH, statins had no significant impact on the pooled RR for recurrent ICH (1.04, 95% CI 0.86 to 1.25; n=23 695); however, statins were associated with significant reductions in mortality (RR 0.49, 95% CI 0.36 to 0.67; n=89 976) and poor functional outcome (RR 0.71, 95% CI 0.67 to 0.75; n=9113). In patients with previous IS, statins were associated with a non-significant increase in ICH (RR 1.36, 95% CI 0.96 to 1.91; n=103 525), but significantly lower risks of recurrent IS (RR 0.74, 95% CI 0.66 to 0.83; n=53 162), any stroke (RR 0.82, 95% CI 0.67 to 0.99; n=55 260), mortality (RR 0.68, 95% CI 0.50 to 0.92; n=74 648) and poor functional outcome (RR 0.83, 95% CI 0.76 to 0.91; n=34 700).
Irrespective of stroke subtype, there were non-significant trends towards future ICH with statins. However, this risk was overshadowed by substantial and significant improvements in mortality and functional outcome among statin users.
CRD42017079863.
他汀类药物是否会增加既往卒中患者发生脑出血（ICH）的风险仍不确定。本研究旨在评估他汀类药物治疗对既往缺血性卒中（IS）或 ICH 患者的 ICH 和其他临床结局的影响。
根据系统评价和荟萃分析的首选报告项目，对比较他汀类药物治疗与对照组（安慰剂或不治疗）的观察性和随机研究进行了系统文献回顾和荟萃分析，纳入了既往有 ICH 或 IS 的患者。采用随机效应荟萃分析，根据卒中亚型汇总主要结局（ICH）和次要结局（IS、任何卒中、死亡率和功能）的风险比（RR）。
共纳入 43 项研究，总随访时间为 317 291 患者年。在既往有 ICH 的患者中，他汀类药物对复发性 ICH 的汇总 RR 无显著影响（1.04，95%CI 0.86 至 1.25；n=23695）；然而，他汀类药物与死亡率降低（RR 0.49，95%CI 0.36 至 0.67；n=89976）和功能不良结局（RR 0.71，95%CI 0.67 至 0.75；n=9113）显著相关。在既往有 IS 的患者中，他汀类药物与 ICH 发生率增加无显著相关性（RR 1.36，95%CI 0.96 至 1.91；n=103525），但与复发性 IS（RR 0.74，95%CI 0.66 至 0.83；n=53162）、任何卒中（RR 0.82，95%CI 0.67 至 0.99；n=55260）、死亡率（RR 0.68，95%CI 0.50 至 0.92；n=74648）和功能不良结局（RR 0.83，95%CI 0.76 至 0.91；n=34700）的风险降低显著相关。
无论卒中亚型如何，他汀类药物治疗均存在未来发生 ICH 的非显著趋势。然而，与他汀类药物使用者死亡率和功能结局的显著改善相比，这种风险相形见绌。
CRD42017079863。
