Statin use and microbleeds in patients with spontaneous intracerebral hemorrhage

Statins have been associated with increased risk of intracerebral hemorrhage (ICH), particularly in elderly patients with previous ICH. Recurrent ICH in the elderly is often related to cerebral amyloid angiopathy. Therefore, we investigated whether statin use is associated with increased prevalence and severity of microbleeds (MB), particularly cortico-subcortical microbleeds (csMB), which are frequently observed in cerebral amyloid angiopathy.

We studied 163 consecutive patients with spontaneous ICH who underwent magnetic resonance imaging within 30 days of presentation. We retrieved clinical information and analyzed magnetic resonance imaging for the presence, location, and number of MB, which were divided into csMB or other (other MB). We performed group comparisons stratified by statin use and by the presence vs absence of any MB (csMB and/or other MB) or csMB alone.

Sixty-four percent had lobar ICH. Overall, 53% had microbleeds and 39% had csMB. Statin users were older, had significantly lower cholesterol and low-density lipoprotein levels, and higher prevalence of hypertension, diabetes, dyslipidemia, and antiplatelet use. The prevalence and number of other MB were similar in statin-treated and statin-untreated individuals. However, more statin-treated patients had csMB (57% vs 33%; P=0.007), with almost twice as many lesions (4.6 ± 11.3 vs 2.4 ± 8.0; P=0.007) compared with untreated patients. Age and statin use were independently associated with both the presence and increased number of MB (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.05; P=0.01 and OR, 2.72; 95% CI. 1.02-7.22; P=0.04, respectively) and csMB (OR, 1.03; 95% CI, 1.00-1.06; P=0.01 and OR, 4.15; 95% CI, 1.54-11.20; P<0.01) in multivariate analyses.

Statin use in patients with ICH is independently associated with MB, especially csMB. Future studies are needed to confirm our findings and to investigate whether csMB can serve as a surrogate marker for ICH risk in statin-treated patients.