title: Statin use following intracerebral hemorrhage: a decision analysis.
abstract: BACKGROUND
  Statins are widely prescribed for primary and secondary prevention of ischemic cardiac and cerebrovascular disease. Although serious adverse effects are uncommon, results from a recent clinical trial suggested increased risk of intracerebral hemorrhage (ICH) associated with statin use. For patients with baseline elevated risk of ICH, it is not known whether this potential adverse effect offsets the cardiovascular and cerebrovascular benefits.
  
  
  OBJECTIVE
  To address the following clinical question: Given a history of prior ICH, should statin therapy be avoided?
  
  
  METHODS
  A Markov decision model was used to evaluate the risks and benefits of statin therapy in patients with prior ICH.
  
  
  METHODS
  Life expectancy, measured as quality-adjusted life-years. We investigated how statin use affects this outcome measure while varying a range of clinical parameters, including hemorrhage location (deep vs lobar), ischemic cardiac and cerebrovascular risks, and magnitude of ICH risk associated with statins.
  
  
  RESULTS
  Avoiding statins was favored over a wide range of values for many clinical parameters, particularly in survivors of lobar ICH who are at highest risk of ICH recurrence. In survivors of lobar ICH without prior cardiovascular events, avoiding statins yielded a life expectancy gain of 2.2 quality-adjusted life-years compared with statin use. This net benefit persisted even at the lower 95% confidence interval of the relative risk of statin-associated ICH. In patients with lobar ICH who had prior cardiovascular events, the annual recurrence risk of myocardial infarction would have to exceed 90% to favor statin therapy. Avoiding statin therapy was also favored, although by a smaller margin, in both primary and secondary prevention settings for survivors of deep ICH.
  
  
  CONCLUSIONS
  Avoiding statins should be considered for patients with a history of ICH, particularly those cases with a lobar location.
authors.affiliation: Massachusetts General Hospital Stroke Research Center, 175 Cambridge Street, Boston, MA 02114, USA.
authors.forename: M Brandon
authors.initials: MB
authors.lastname: Westover
authors.forename: Matt T
authors.initials: MT
authors.lastname: Bianchi
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000150:complications / Q000517:prevention & control; D015986:Confounding Factors, Epidemiologic; D000075202:Contraindications; D003661:Decision Support Techniques; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors