title: Statins and intracerebral hemorrhage: collaborative systematic review and meta-analysis.
abstract: BACKGROUND
  A recent large, randomized trial suggested that statins may increase the risk of intracerebral hemorrhage. Accordingly, we systematically reviewed the association of statins with intracerebral hemorrhage in randomized and observational data.
  
  
  RESULTS
  We screened 17 electronic bibliographic databases to identify eligible studies and consulted with experts in the field. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals. Randomized trials, cohort studies, and case-control studies were analyzed separately. Only adjusted risk estimates were used for pooling observational data. We included published and unpublished data from 23 randomized trials and 19 observational studies. The complete data set comprised 248 391 patients and 14 784 intracerebral hemorrhages. Statins were not associated with an increased risk of intracerebral hemorrhage in randomized trials (risk ratio, 1.10; 95% confidence interval, 0.86-1.41), cohort studies (risk ratio, 0.94; 95% confidence interval, 0.81-1.10), or case-control studies (risk ratio, 0.60; 95% confidence interval, 0.41-0.88). Substantial statistical heterogeneity was evident for the case-control studies (I(2)=66%, P=0.01), but not for the cohort studies (I(2)=0%, P=0.48) or randomized trials (I(2)=30%, P=0.09). Sensitivity analyses by study design features, patient characteristics, or magnitude of cholesterol lowering did not materially alter the results.
  
  
  CONCLUSIONS
  We found no evidence that statins were associated with intracerebral hemorrhage; if such a risk is present, its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs.
authors: University of Western Ontario, London, Canada. dhackam@uwo.ca
authors: Daniel G
authors: DG
authors: Hackam
authors: Mark
authors: M
authors: Woodward
authors: L Kristin
authors: LK
authors: Newby
authors: Deepak L
authors: DL
authors: Bhatt
authors: Mingyuan
authors: M
authors: Shao
authors: Eric E
authors: EE
authors: Smith
authors: Allan
authors: A
authors: Donner
authors: Muhammad
authors: M
authors: Mamdani
authors: James D
authors: JD
authors: Douketis
authors: Hisatomi
authors: H
authors: Arima
authors: John
authors: J
authors: Chalmers
authors: Stephen
authors: S
authors: MacMahon
authors: David L
authors: DL
authors: Tirschwell
authors: Bruce M
authors: BM
authors: Psaty
authors: Cheryl D
authors: CD
authors: Bushnell
authors: Maria I
authors: MI
authors: Aguilar
authors: Dan J
authors: DJ
authors: Capampangan
authors: David J
authors: DJ
authors: Werring
authors: Paola
authors: P
authors: De Rango
authors: Anand
authors: A
authors: Viswanathan
authors: Nicolas
authors: N
authors: Danchin
authors: Ching-Lan
authors: CL
authors: Cheng
authors: Yea-Huei Kao
authors: YH
authors: Yang
authors: B Marianne
authors: BM
authors: Verdel
authors: Mei-Shu
authors: MS
authors: Lai
authors: James
authors: J
authors: Kennedy
authors: Shinichiro
authors: S
authors: Uchiyama
authors: Takenori
authors: T
authors: Yamaguchi
authors: Yasuo
authors: Y
authors: Ikeda
authors: Marko
authors: M
authors: Mrkobrada
mesh_terms: D000818:Animals; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D015331:Cohort Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors