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Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

BACKGROUND: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. METHODS: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and c...

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Autores principales: Teoh, Ru Jian Jonathan, Huang, Chi-Jung, Chan, Chi Peng, Chien, Li-Yin, Chung, Chih-Ping, Sung, Shih-Hsien, Chen, Chen-Huan, Chiang, Chern-En, Cheng, Hao-Min
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657129/
https://www.ncbi.nlm.nih.gov/pubmed/31384308
http://dx.doi.org/10.1177/1756286419864830
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author Teoh, Ru Jian Jonathan
Huang, Chi-Jung
Chan, Chi Peng
Chien, Li-Yin
Chung, Chih-Ping
Sung, Shih-Hsien
Chen, Chen-Huan
Chiang, Chern-En
Cheng, Hao-Min
author_facet Teoh, Ru Jian Jonathan
Huang, Chi-Jung
Chan, Chi Peng
Chien, Li-Yin
Chung, Chih-Ping
Sung, Shih-Hsien
Chen, Chen-Huan
Chiang, Chern-En
Cheng, Hao-Min
author_sort Teoh, Ru Jian Jonathan
collection PubMed
description BACKGROUND: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. METHODS: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and conclusiveness of the available evidence in the meta-analysis. To evaluate the overall effectiveness, the net composite endpoints were derived by totaling ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), myocardial infarction, and cardiovascular mortality. RESULTS: A total of 17 trials with 11,576 subjects with previous ischemic stroke, TIA, or ICH were included, in which statin therapy increased the risk of hemorrhagic stroke (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.07–1.87), but reduced the risk of ischemic stroke (RR, 0.85; 95% CI, 0.75–0.95). For the net composite endpoints, statin therapy was associated with a 17% risk reduction (95% CI, 12–21%; number needed to treat = 6). With a control event rate 2% and RR increase 40%, the TSA suggested a conclusive signal of an increased risk of hemorrhagic stroke in stroke survivors taking statin. However, with the sensitivity analysis by changing assumptions, the conclusions about hemorrhagic stroke risk were less robust. CONCLUSIONS: Statin therapy in poststroke patients increased the risk of hemorrhagic stroke but effectively reduced ischemic stroke risk. Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or TIA. However, more studies are required to investigate the conclusiveness of the increased hemorrhagic stroke risk revealed in our study.
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spelling pubmed-66571292019-08-05 Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis Teoh, Ru Jian Jonathan Huang, Chi-Jung Chan, Chi Peng Chien, Li-Yin Chung, Chih-Ping Sung, Shih-Hsien Chen, Chen-Huan Chiang, Chern-En Cheng, Hao-Min Ther Adv Neurol Disord Meta-Analysis BACKGROUND: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. METHODS: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and conclusiveness of the available evidence in the meta-analysis. To evaluate the overall effectiveness, the net composite endpoints were derived by totaling ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), myocardial infarction, and cardiovascular mortality. RESULTS: A total of 17 trials with 11,576 subjects with previous ischemic stroke, TIA, or ICH were included, in which statin therapy increased the risk of hemorrhagic stroke (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.07–1.87), but reduced the risk of ischemic stroke (RR, 0.85; 95% CI, 0.75–0.95). For the net composite endpoints, statin therapy was associated with a 17% risk reduction (95% CI, 12–21%; number needed to treat = 6). With a control event rate 2% and RR increase 40%, the TSA suggested a conclusive signal of an increased risk of hemorrhagic stroke in stroke survivors taking statin. However, with the sensitivity analysis by changing assumptions, the conclusions about hemorrhagic stroke risk were less robust. CONCLUSIONS: Statin therapy in poststroke patients increased the risk of hemorrhagic stroke but effectively reduced ischemic stroke risk. Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or TIA. However, more studies are required to investigate the conclusiveness of the increased hemorrhagic stroke risk revealed in our study. SAGE Publications 2019-07-24 /pmc/articles/PMC6657129/ /pubmed/31384308 http://dx.doi.org/10.1177/1756286419864830 Text en © The Author(s), 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Meta-Analysis
Teoh, Ru Jian Jonathan
Huang, Chi-Jung
Chan, Chi Peng
Chien, Li-Yin
Chung, Chih-Ping
Sung, Shih-Hsien
Chen, Chen-Huan
Chiang, Chern-En
Cheng, Hao-Min
Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis
title Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis
title_full Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis
title_fullStr Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis
title_full_unstemmed Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis
title_short Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis
title_sort does statin increase the risk of intracerebral hemorrhage in stroke survivors? a meta-analysis and trial sequential analysis
topic Meta-Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657129/
https://www.ncbi.nlm.nih.gov/pubmed/31384308
http://dx.doi.org/10.1177/1756286419864830
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