Withdrawal of statins and risk of subarachnoid hemorrhage.
OBJECTIVE
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Risselada
Roelof
R
Department of Medical Informatics, Erasmus MC, room Ee 2159, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. r.risselada@erasmusmc.nl
Straatman
Huub
H
van Kooten
Fop
F
Dippel
Diederik W J
DW
van der Lugt
Aad
A
Niessen
Wiro J
WJ
Firouzian
Azadeh
A
Herings
Ron M C
RM
Sturkenboom
Miriam C J M
MC
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000453:epidemiology
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors