title: Aggressive statin treatment, very low serum cholesterol levels and haemorrhagic stroke: is there an association?
abstract: OBJECTIVE
  To assess the potential association between haemorrhagic stroke and achieving very low serum cholesterol levels with aggressive statin treatment.
  
  
  RESULTS
  The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed a reduction in both fatal and nonfatal stroke but an increase in the risk for haemorrhagic stroke during high-dose atorvastatin treatment. However, post-hoc analyses of this trial showed that this increased risk is primarily observed in elderly men with a history of haemorrhagic stroke. In addition, there was no relationship between baseline or on-treatment low-density lipoprotein cholesterol (LDL-C) levels and haemorrhagic stroke.
  
  
  CONCLUSIONS
  Existing data suggest that low LDL-C levels during intensive statin treatment are not associated with an increased risk for haemorrhagic stroke, except in patients with a history of intracerebral haemorrhage. In patients with a history of ischaemic stroke, intensive statin treatment substantially reduces the risk for both recurrent ischaemic stroke and for coronary heart disease (CHD) events. Any possible excess of haemorrhagic stroke is greatly outweighed by the protective effect against ischaemic stroke and CHD events.
authors.affiliation: Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
authors.forename: Vasilios G
authors.initials: VG
authors.lastname: Athyros
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tziomalos
authors.forename: Asterios
authors.initials: A
authors.lastname: Karagiannis
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Wierzbicki
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
mesh_terms: D000924:Anticholesteremic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069059:Atorvastatin; D002545:Brain Ischemia / Q000139:chemically induced / Q000209:etiology; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000517:prevention & control; D006538:Heptanoic Acids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control; D011322:Primary Prevention; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000139:chemically induced* / Q000209:etiology
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin