Katsanos Aristeidis H, Lioutas Vasileios-Arsenios, Charidimou Andreas, Catanese Luciana, Ng Kelvin Kuan Huei, Perera Kanjana, de Sa Boasquevisque Danielle, Falcone Guido J, Sheth Kevin N, Romero Jose Rafael, Tsivgoulis Georgios, Smith Eric E, Sharma Mukul, Selim Magdy H, Shoamanesh Ashkan
Division of Neurology, McMaster University / Population Health Research Institute, Hamilton, ON, Canada.
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Neurol Sci. 2021 Jan 15;420:117224. doi: 10.1016/j.jns.2020.117224. Epub 2020 Nov 8.
Although statins have been associated with increased risk of spontaneous intracerebral hemorrhage, their relationship with cerebral microbleeds (CMBs) formation is poorly understood. We systematically reviewed previously published studies reporting on the association between CMBs presence and current statin use. We performed a systematic search in MEDLINE and SCOPUS databases on October 24, 2019 to identify all cohorts from randomized-controlled clinical trials or observational studies reporting on CMB prevalence and statin use. We extracted cross-sectional data on CMBs presence, as provided by each study, in association to the history of current statin use. Random effects model was used to calculate the pooled estimates. We included 7 studies (n = 3734 participants): unselected general population [n = 1965], ischemic stroke [n = 849], hemorrhagic stroke [n = 252] and patients with hypertension over the age of 60 [n = 668]. Statin use was not associated with CMBs presence in either unadjusted (OR = 1.15, 95%CI: 0.76-1.74) or adjusted analyses (OR = 1.09, 95%CI: 0.64-1.86). Statin use was more strongly related to lobar CMB presence (OR = 2.01, 95%CI: 1.48-2.72) in unadjusted analysis. The effect size of this association was consistent, but no longer statistically significant in adjusted analysis that was confined to two eligible studies (OR = 2.26, 95%CI: 0.86-5.91). Except for the analysis on the unadjusted probability of lobar CMBs presence, considerable heterogeneity was present in all other analyses (I > 60%). Our findings suggest that statin treatment seems not to be associated with CMBs overall, but may increase the risk of lobar CMB formation. This hypothesis deserves further investigation within magnetic resonance imaging ancillary studies of randomized trials.
尽管他汀类药物与自发性脑出血风险增加有关，但其与脑微出血（CMB）形成之间的关系仍知之甚少。我们系统回顾了先前发表的关于CMB存在与当前他汀类药物使用之间关联的研究。2019年10月24日，我们在MEDLINE和SCOPUS数据库中进行了系统检索，以识别所有来自随机对照临床试验或观察性研究的队列，这些研究报告了CMB患病率和他汀类药物使用情况。我们提取了每项研究提供的关于CMB存在的横断面数据，并将其与当前他汀类药物使用史相关联。采用随机效应模型计算合并估计值。我们纳入了7项研究（n = 3734名参与者）：未选择的普通人群[n = 1965]、缺血性卒中[n = 849]、出血性卒中[n = 252]以及60岁以上的高血压患者[n = 668]。在未调整分析（OR = 1.15，95%CI：0.76 - 1.74）或调整分析（OR = 1.09，95%CI：0.64 - 1.86）中，他汀类药物的使用与CMB的存在均无关联。在未调整分析中，他汀类药物的使用与脑叶CMB的存在关联更强（OR = 2.01，95%CI：1.48 - 2.72）。这种关联的效应大小是一致的，但在仅限于两项符合条件的研究的调整分析中不再具有统计学意义（OR = 2.26，95%CI：0.86 - 5.91）。除了对脑叶CMB存在的未调整概率分析外，所有其他分析中均存在相当大的异质性（I²>60%）。我们的研究结果表明，他汀类药物治疗总体上似乎与CMB无关，但可能会增加脑叶CMB形成的风险。这一假设值得在随机试验的磁共振成像辅助研究中进一步探究。
