title: Risk of Intracranial Hemorrhage From Statin Use in Asians: A Nationwide Cohort Study.
abstract: BACKGROUND
  Reports of statin usage and increased risk of intracranial hemorrhage (ICH) have been inconsistent. This study examined potential associations between statin usage and the risk of ICH in subjects without a previous history of stroke.
  
  
  RESULTS
  Patients initiating statin therapy between 2005 and 2009 without a previous history of ischemic or hemorrhagic stroke were identified from Taiwan's National Health Insurance database. Participants were stratified by advanced age (≥70 years), sex, and diagnosed hypertension. The outcome of interest was hospital admission for ICH (International Classification of Diseases, Ninth Revision, Clinical Modification codes 430, 431, 432). Cox regression models were applied to estimate the hazard ratio of ICH. The cumulative statin dosage stratified by quartile and adjusted for baseline disease risk score served as the primary variable using the lowest quartile of cumulative dosage as a reference. There were 1 096 547 statin initiators with an average follow-up of 3.3 years. The adjusted hazard ratio for ICH between the highest and the lowest quartile was nonsignificant at 1.06 with a 95% confidence interval spanning 1.00 (0.94-1.19). Similar nonsignificant results were found in sensitivity analyses using different outcome definitions or model adjustments, reinforcing the robustness of the study findings. Subgroup analysis identified an excess of ICH frequency in patients without diagnosed hypertension (adjusted hazard ratio 1.36 [1.11-1.67]).
  
  
  CONCLUSIONS
  In general, no association was observed between cumulative statin use and the risk of ICH among subjects without a previous history of stroke. An increased risk was identified among the nonhypertensive cohort, but this finding should be interpreted with caution.
authors: From Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-H.C.); Department of Medicine, College of Medicine, National Taiwan University, Taipei (C.-H.C., J.-W.L.); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei (C.-H.C., Y.-C. Lee, Y.-C. Liu, M.-S.L.); Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.L.); Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth (J.L.C.); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (Y.-C. Lee); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County (J.-W.L.).
authors: Chia-Hsuin
authors: CH
authors: Chang
authors: From Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-H.C.); Department of Medicine, College of Medicine, National Taiwan University, Taipei (C.-H.C., J.-W.L.); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei (C.-H.C., Y.-C. Lee, Y.-C. Liu, M.-S.L.); Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.L.); Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth (J.L.C.); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (Y.-C. Lee); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County (J.-W.L.).
authors: Chin-Hsien
authors: CH
authors: Lin
authors: From Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-H.C.); Department of Medicine, College of Medicine, National Taiwan University, Taipei (C.-H.C., J.-W.L.); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei (C.-H.C., Y.-C. Lee, Y.-C. Liu, M.-S.L.); Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.L.); Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth (J.L.C.); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (Y.-C. Lee); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County (J.-W.L.).
authors: James L
authors: JL
authors: Caffrey
authors: From Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-H.C.); Department of Medicine, College of Medicine, National Taiwan University, Taipei (C.-H.C., J.-W.L.); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei (C.-H.C., Y.-C. Lee, Y.-C. Liu, M.-S.L.); Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.L.); Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth (J.L.C.); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (Y.-C. Lee); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County (J.-W.L.).
authors: Yen-Chieh
authors: YC
authors: Lee
authors: From Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-H.C.); Department of Medicine, College of Medicine, National Taiwan University, Taipei (C.-H.C., J.-W.L.); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei (C.-H.C., Y.-C. Lee, Y.-C. Liu, M.-S.L.); Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.L.); Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth (J.L.C.); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (Y.-C. Lee); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County (J.-W.L.).
authors: Ying-Chun
authors: YC
authors: Liu
authors: From Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-H.C.); Department of Medicine, College of Medicine, National Taiwan University, Taipei (C.-H.C., J.-W.L.); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei (C.-H.C., Y.-C. Lee, Y.-C. Liu, M.-S.L.); Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.L.); Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth (J.L.C.); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (Y.-C. Lee); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County (J.-W.L.). jouweilin@yahoo.com.
authors: Jou-Wei
authors: JW
authors: Lin
authors: From Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-H.C.); Department of Medicine, College of Medicine, National Taiwan University, Taipei (C.-H.C., J.-W.L.); Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei (C.-H.C., Y.-C. Lee, Y.-C. Liu, M.-S.L.); Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.L.); Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth (J.L.C.); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (Y.-C. Lee); and Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County (J.-W.L.).
authors: Mei-Shu
authors: MS
authors: Lai
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Taiwan; cohort studies; hydroxymethylglutaryl-CoA reductase inhibitors; intracranial hemorrhages