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Statins and the Risk of Intracerebral Hemorrhage in Patients With Previous Ischemic Stroke or Transient Ischemic Attack

Background and Purpose— Although there is no overall association between statin use and intracerebral hemorrhage (ICH), whether there is an increased risk among those with a history of ischemic stroke (IS) or transient ischemic attack (TIA) remains controversial. We evaluated the relationship of preadmission statin use with the risk of ICH in patients with a history of IS or TIA in a population-based cohort. Methods— The Health Improvement Network primary care database in the United Kingdom was used to identify new users of low-dose aspirin and a matched comparison. Both cohorts were followed to identify incident cases of ICH, with validation by manual review of patient records and linkage to hospitalization data. In a nested case–control study, we compared the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for ICH based on statin use in the subgroup of individuals with history of IS/TIA. Results— Last statin use within 1 year of ICH (OR, 0.92; 95% CI [confidence interval], 0.60–1.4), last use between 8 days and 1 year (OR, 1.81; 95% CI, 0.99–3.28), and statin use at the time of ICH (OR, 0.77; 95% CI, 0.49–1.21) were not associated with the overall ICH risk among 157 patients with ICH and 884 controls with a history of IS/TIA. There was also no difference in 30-day rates of fatal (OR, 0.82; 95% CI, 0.41–1.64) or nonfatal (OR, 0.90; 95% CI, 0.51–1.57) ICH. Conclusions— Statin use was not associated with an increased risk of ICH among patients with a previous history of IS/TIA.