title: Association of statins and statin discontinuation with poor outcome and survival after intracerebral hemorrhage.
abstract: OBJECTIVE
  Studies suggest a protective role for statins after intracerebral hemorrhage, but many failed to assess statin discontinuation, did not include postdischarge outcomes, or did not account for withdrawal of care. We studied the relationship between preintracerebral hemorrhage statin use and in-hospital statin discontinuation on stroke severity and 30-day mortality.
  
  
  METHODS
  We analyzed data from the Registry of the Canadian Stroke Network and determined the adjusted ORs for statin use and outcomes, controlling for stroke severity and other covariates.
  
  
  RESULTS
  We analyzed 2466 consecutive patients with intracerebral hemorrhage from 2003 to 2008: median age was 71 years, 53.6% were male, and 30-day mortality rate was 36.5%. Overall, 537 (21.7%) were taking statins before presentation. Compared with nonusers, statin users were less likely to have severe strokes on presentation (54.7% versus 63.3%) but had similar rates of poor outcome (70% versus 67%) and 30-day mortality (36% versus 37%). Statins were discontinued on admission in 158 of 537 (29.4%); these patients were more likely to have severe stroke (65% versus 27%, P<0.01), poor outcome (90% versus 62%, P<0.01), and to have died by 30 days (71% versus 21%, P<0.01). After adjusting for stroke severity, statin discontinuation was still associated with poor outcome (adjusted OR, 2.4; 95% CI, 1.13-4.56) and higher mortality (adjusted OR, 2.0; 95% CI, 1.30-3.04). However, these associations were attenuated and no longer significant after excluding patients treated palliatively.
  
  
  CONCLUSIONS
  We found no association between preadmission statin use and outcomes in intracerebral hemorrhage. Statin discontinuation may worsen outcomes or may simply be a marker of worse underlying prognosis.
authors.affiliation: Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada. ddowlat@ottawahospital.on.ca
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Mukul
authors.initials: M
authors.lastname: Sharma
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors