Related Experiment Video
Updated: Mar 22, 2026
Using Zebrafish Larvae to Study the Pathological Consequences of Hemorrhagic Stroke
Published on: June 5, 2019
Statin Dose and the Risk of Intracerebral Hemorrhage: A Population-Based Longitudinal Study in Taiwan
Shih-Jie Jhuo1, Wei-Chung Tsai1, Tsung-Hsien Lin2
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital;
Insights
High-dose statin (HDS) treatment, compared to low-dose statin (LDS), was associated with a reduced risk of intracerebral hemorrhage (ICH). This study found no significant increase in myocardial infarction or new-onset diabetes mellitus with HDS.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- High-dose statin (HDS) therapy is increasingly used to reduce vascular events.
- Concerns exist regarding the potential risk of intracerebral hemorrhage (ICH) with HDS.
- Lipid treatment guidelines often recommend high statin dosages for high-risk patients.
Purpose of the Study:
- To investigate the association between different statin dosages and the risk of ICH.
- To evaluate the impact of HDS on secondary endpoints including ischemic stroke (IS), myocardial infarction (MI), and new-onset diabetes mellitus (NDM).
Main Methods:
- A national population-based cohort study utilizing Taiwan's National Health Insurance Research Database (2001-2008).
- Patients with cerebrovascular or cardiovascular disease were categorized into HDS, moderate-dose statin (MDS), and low-dose statin (LDS) groups based on annual atorvastatin dosage.
- Cox regression analysis was employed to assess the risk of primary (ICH) and secondary endpoints after adjusting for covariates.
Main Results:
- After adjusting for age, gender, diabetes, and hypertension, both HDS and MDS groups showed a significantly lower risk of ICH compared to the LDS group (HR 0.49 and 0.45, respectively).
- HDS treatment was associated with a reduced risk of ischemic stroke (IS) (HR 0.68).
- No statistically significant differences in the risk of myocardial infarction (MI) or new-onset diabetes mellitus (NDM) were observed between the different statin dose groups.
Conclusions:
- Real-world data from Taiwan indicate that higher statin doses are associated with a reduced, not elevated, risk of intracerebral hemorrhage.
- HDS therapy may be safely used in high-risk populations without increasing the risk of ICH.
- The findings support the use of HDS for vascular event prevention, addressing prior safety concerns regarding ICH.
Background:
In the last 15 years, there has been considerable interest in statin use as a means to reduce the likelihood of vascular events. Several clinical trials have shown that high-dose statin (HDS) treatment could reduce vascular events. In high-risk populations, lipid treatment guidelines have generally suggested prescribing statin up to the highest recommended dosage. However, there remains concern about the risk of intracerebral hemorrhage (ICH) with HDS treatment.
Methods:
This was a national population-based cohort study from the National Health Insurance Research Database of Taiwan extending from July 2001 to December 2008. Patients with cerebrovascular or cardiovascular disease were enrolled. The HDS group was defined as those patients receiving more than 420 mg per year of atorvastatin or an equivalent potency statin. Moderate dose statin group (MDS) was defined as those patients receiving atorvastatin in amounts between 196-420 mg per year or an equivalent potency statin. Low dose statin (LDS) group was defined as those receiving less than 196 mg per year of atorvastatin or an equivalent statin. The primary endpoint is ICH. The secondary endpoints are myocardial infarction (MI), ischemic stroke (IS) and new-onset DM (NDM).
Results:
A total of 5459 patients were enrolled in our study, with study participant ages ranging from 62.91 ± 11.85 years and a mean follow-up time of 2039 ± 6 days. After adjusting for age, gender, diabetes and hypertension, Cox regression analysis found ICH risk was lower in HDS and MDS groups compared with LDS (HR 0.49, 95% CI 0.26-0.91, p = 0.0246 and HR 0.45, 95% CI 0.24-0.86, p = 0.0157). The risk of IS is lower in patients with HDS treatment (HR 0.68, 95% CI 0.55-0.83, p < 0.01). However, the risk of MI and NDM incidence are not statistically significant between the different dose groups.
Conclusions:
In the real-world data provided by Taiwan's National Health Insurance research database, it was shown that patients who received a higher dose of statin had a reduced and not elevated risk of intracerebral hemorrhage.
Key Words:
High-dose statin; Hyperlipidemia; Intracerebral hemorrhage; Ischemic stroke; New-onset DM.
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:26Atherosclerosis III: Management
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...