Association of Statin Therapy with Functional Outcomes and Survival in Intracerebral and Subarachnoid Hemorrhage

Background/Objectives: Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are severe forms of stroke with high morbidity and mortality rates. HMG-CoA reductase inhibitors, commonly referred to as statins, known for their lipid-lowering abilities, also possess pleiotropic properties, including anti-inflammatory and neuroprotective effects. We aimed to evaluate the impact of statin therapy on the functional outcomes and survival in patients with ICH and SAH. Methods: This retrospective cohort study analyzed data from the Get With The Guidelines (GWTG) stroke registry at a tertiary care center, including patients diagnosed with ICH or SAH between January 2008 and June 2022. Patients were categorized based on prior initiation of statin therapy: no statin, low-intensity statin, or high-intensity statin. The primary outcome was the Modified Rankin Scale (mRS) score at discharge, dichotomized to good (0-2) and poor (3-6) outcomes. A multivariate logistic regression model controlled for age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission. Results: A total of 663 patients with ICH and 159 patients with SAH were included in the analysis. In the ICH patients, low-intensity statin therapy was associated with significantly higher odds of a good functional outcome (aOR 2.56, 95% CI 1.247-5.246, p = 0.0104), as was high-intensity statin therapy (aOR 2.445, 95% CI 1.313-4.552, p = 0.0048). Among the SAH patients, all 39 deaths occurred in the no statin therapy group. Conclusions: Both low- and high-intensity statin therapy are associated with improved functional outcomes in ICH and may offer a survival benefit in SAH. These findings highlight the potential neuroprotective role of statins in hemorrhagic stroke. Further prospective studies and randomized controlled trials are needed to confirm these observations and to clarify the optimal use of statins in this patient population.