Doctors know that drugs called statins lower a person’s risk of a stroke due to a blood clot. But a new study shows that the inexpensive medications can also decrease the risk of a first stroke as a result of an intracerebral hemorrhage, the deadliest kind.
An intracerebral hemorrhage is when blood from an artery suddenly begins to bleed into the brain. It’s the second most common cause of a stroke after a blood clot, which is called an ischemic stroke.
Stroke is a leading cause of death and disability in the US, the US Centers for Disease Control and Prevention says. Many can be prevented through lifestyle changes such as eating healthy, getting exercise and quitting smoking.
Statins are another powerful tool for stroke prevention. They work by reducing fatty deposits in the arteries and keeping them from building up to cut off blood to the brain. Globally, hundreds of millions of people take them to prevent heart problems or stroke.
There has been conflicting research on whether a statin can reduce a person’s risk of a first intracerebral hemorrhage. The new study, published Wednesday in the journal Neurology, seems to put a cap on some of that debate.
The researchers used prescription data and the health records of more than 88,000 people in Denmark who did not have a history of stroke. During the study period, 989 people (with an average age of 76) had a first bleeding stroke in the lobe area of the brain, and 1,175 (with an average age of 75) had one in the other parts of the brain.
The researchers distinguished between lobar vs. nonlobar strokes so they could look for differences in strokes in different parts of the brain; nonlobar strokes are often caused by high blood pressure.
The research was partially funded by the Novo Nordisk Foundation. The pharmaceutical company Novo Nordisk makes drugs for the treatment of stroke, but the foundation was not involved in the study design or interpretation of the data, the researchers say.
People in the study who used statins for any period of time had a 17% lower risk of a stroke in the lobe areas of the brain and a 16% lower risk of a stroke in the non-lobe areas of the brain. When they used a statin for more than five years, they had a 33% lower risk of a bleeding stroke in the lobe areas and a 38% lower risk in the non-lobe areas.
“It’s reassuring news for people taking statins that these medications seem to reduce the risk of bleeding stroke as well as the risk of stroke from blood clots,” said study co-author Dr. David Gaist, a professor of the University of Southern Denmark in Odense.
The study has some limitations, however. It lacked data on potentially important underlying conditions that could lead to a stroke and other information about behaviors that could raise a person’s risk, such as smoking or alcohol use. There would also need to be additional research to determine whether the results would be the same in non-European populations.
A large ongoing trial funded by the US National Institutes of Health is trying to determine whether people who have been on statins and are admitted to a hospital with a hemorrhagic stroke should keep using the drug or stop taking it.
Some research has suggested that people who have a history of stroke due to a blood clot, called an ischemic stroke, may have a higher risk of a hemorrhagic stroke if they take a statin.
“There were these small exploratory studies off of randomized trials that suggested the possibility there was an increased risk of hemorrhagic stroke if there had been a history of ischemic stroke. So that’s thrown us off a bit,” said Dr. Pooja Khatri, a professor and division chief of neurology and rehabilitation medicine at the University of Cincinnati College of Medicine. She works regularly with people who have had strokes and was not involved in the new research.
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She said this study shows what biologically makes sense: Taking statins and keeping fatty deposits from building up in the arteries makes hemorrhagic strokes less likely.
“Studies like this latest one sort of put the nail in the coffin because they’re larger and they’re so comprehensive and population-based. This study tells me that if a patient has never had a stroke and they have indications, a statin is definitely a good idea,” Khatri said. “It makes us think that we are right to be certain that overall, patients are better off on statins.”