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Las estatinas y la hemorragia intracerebral: revisión sistemática colaborativa y metanálisis
Daniel G Hackam1, Mark Woodward, L Kristin Newby
1University of Western Ontario, London, Canada. dhackam@uwo.ca
Circulation
|October 19, 2011
Resumen
Las estatinas no aumentan el riesgo de hemorragia intracerebral, según una revisión sistemática de estudios aleatorizados y observacionales. Cualquier riesgo potencial es pequeño y superado por los beneficios cardiovasculares.
Área de la Ciencia:
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Neurología Neurología.
- Farmacología Farmacología.
Sus antecedentes:
- Un ensayo previo sugirió que las estatinas podrían elevar el riesgo de hemorragia intracerebral.
- Esta revisión sistemática aborda la asociación entre las estatinas y la hemorragia intracerebral.
Objetivo del estudio:
- Revisar sistemáticamente la asociación de las estatinas con el riesgo de hemorragia intracerebral.
- Para analizar los datos de ambos ensayos controlados aleatorios y estudios observacionales.
Principales métodos:
- Realizó una búsqueda sistemática en 17 bases de datos y consultó a expertos.
- Se agruparon datos de 23 ensayos aleatorizados y 19 estudios observacionales (248.391 pacientes, 14.784 hemorragias).
- Se utilizaron modelos de efectos aleatorios para calcular ratios de riesgo resumidos, analizando diseños de estudio por separado.
Principales resultados:
- No se encontró un mayor riesgo de hemorragia intracerebral en ensayos aleatorizados (RR 1.10), estudios de cohorte (RR 0.94) o estudios de caso y control (RR 0.60).
- La heterogeneidad se observó en los estudios de casos y controles (I2=66%) pero no en los estudios de cohorte (I2=0%) ni en los ensayos aleatorizados (I2=30%).
- Los análisis de sensibilidad confirmaron estos hallazgos a través de varias características del paciente y del estudio.
Conclusiones:
- No hay evidencia que apoye una asociación entre el uso de estatinas y la hemorragia intracerebral.
- Si existe un riesgo, es probable que sea pequeño y superado por los beneficios cardiovasculares significativos de las estatinas.
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