The Medicine Guy
"Statins" and hemorrhagic stroke

January 11, 2011

A study published yesterday suggests that certain cholesterol lowering medications should be avoided in people who have a history of hemorrhagic stroke. This is getting tons of news, so many of you may be wondering why this is or if this applies to you.

The cholesterol lowering medications in question are the “statins”, including drugs such as Lipitor, Crestor, and Zocor. A hemorrhagic stroke is a stroke that occurs as a result of bleeding in the brain, as compared to an ischemic stroke which is usually caused by a blood clot.

I first want to point out that this is not breaking news. This has been a concern for several years now, ever since a major study showed that although statins are effective at preventing ischemic strokes in certain patients, they may cause an increased risk of hemorrhagic strokes. The benefit of preventing the ischemic strokes is so large though that it is usually worth the risk of the rarer hemorrhagic stroke. But the concern is that the benefit won’t be enough in people who have already had a hemorrhagic stroke before, since their risk of recurrence is very high.

The study published yesterday was not collecting any new information. This is important, since the type of study performed is not considered the best quality evidence for making decisions in the medical field. It was simply a mathematical model of information that we already know, used to simulate what the benefit/risk ratio of using a statin is in certain patients. The model suggests that the benefit does not outweigh the risk if someone has had a prior hemorrhagic stroke.

This could get insanely long and boring, so I’ll cut to the chase. Based on this study and the results of previous studies, in most cases it is probably too dangerous to take a statin if you have a history of hemorrhagic stroke. This can be said much more strongly if you have had the stroke recently. I do want to caution, however, that this is based on very limited scientific information. It is not known if lower doses of statins, or if statins other than Lipitor and Zocor increase hemorrhagic stroke risk. And in some patients with heart disease, the benefit of taking a statin might outweigh the risk of stroke anyway. There is often a fine line between a treatment being beneficial overall or being harmful overall, so it could differ for every individual. I will just encourage you to speak with your doctor if you have a history of hemorrhagic stroke and have been prescribed a statin.

Aaron Emmel, PharmD, BCNSP

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