Reader response: Association of statin use with spontaneous intracerebral hemorrhage: A cohort study

Abstract

The article by Saliba et al.1 further informs the debate on the important topic of statin use and spontaneous intracerebral hemorrhage. In our original Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial report (atorvastatin 80 mg/d vs placebo for secondary stroke prevention),2 we indicated that our analysis of the type of outcome stroke (ischemic, hemorrhagic, or unclassified) was unplanned and that the small numbers of participants with a baseline brain hemorrhage precluded meaningful conclusions in this population. A meta-analysis (17,000 participants; 26 randomized trials) found that more vs less intensive statin therapy reduced first ischemic strokes (risk ratio [RR] 0.84, 99% confidence interval [CI] 0.71–0.99; p = 0.005) and nonsignificantly increased hemorrhagic strokes (RR 1.21, 99% CI 0.76–1.91; p = 0.3).3 The meta-analysis did not address the risks of high-intensity statins for secondary stroke prevention. In the current analysis,1 statin dose was categorized as an average atorvastatin equivalent daily dose (AAEDD) of <10, 10–19.9, and >20 mg/d. Although no interaction between AAEDD and previous stroke/TIA was found, given that the limited initial and subsequent exploratory SPARCL analyses prompted much of the debate regarding statin risk for secondary stroke prevention,2,4,5 it would be helpful to provide an analysis for participants with prior stroke who received an AEDD of 80 mg/d.