Stroke: What are the risk factors for intracerebral hemorrhage?

Although the meta-analysis of statin trials showed that there was no significant increase in intracranial hemorrhage (ICH), the occurrence of ICH in patients taking statins is still a concern of the medical community
.

The recommendations for stroke patients are based on the results of the SPARCL trial (preventing stroke by actively lowering cholesterol levels), which found that stroke patients who used atorvastatin 80 mg per day and patients without known coronary heart disease compared with placebo The relative risk of carotid artery stenosis was reduced by 16%, and a sub-analysis of the trial showed that the relative risk was reduced by 33% in randomized patients with carotid artery stenosis
.

In the SPARCL trial, the 5-year risk of hemorrhagic stroke increased, but it did not exceed the benefits of atorvastatin treatment
.

In the TST trial (Treat Stroke to Target), patients with ischemic stroke and evidence of atherosclerosis (extracranial or intracranial artery stenosis, or aortic arch plaque thickness ≥ 4 mm or a history of symptomatic coronary artery disease), Patients designated as a target LDL cholesterol level of <70 mg/dL, compared with patients designated as a target LDL cholesterol level of 100±10 mg/dL, have significantly reduced major cardiovascular events
.

In the pre-specified analysis of the TST trial, Bichat Hospital in Paris and others, aimed to assess the baseline and treatment predictors of ICH
.

Patients who have had an ischemic stroke in the past 3 months or who have had a transient ischemic attack in the past 15 days and have evidence of cerebrovascular or coronary atherosclerosis will be randomly assigned to the target LDL (low density Lipoprotein) cholesterol <70 mg/dL or 100±10 mg/dL, use statin or ezetimibe
.

Among the 2860 patients enrolled, 31 cases of ICH occurred during the 3-year median follow-up (18 cases and 13 cases in the low target group and high target group, respectively, 3.
21/1000 patient-years [95%CI, 2.
38 -4.
04] and 2.
32/1000 patient-years [95%CI, 1.
61-3.
03])
.

Although there are no baseline predictors of ICH, uncontrolled hypertension (HR, 2.
51 [95% CI, 1.
01-6.
31], P=0.
041) and anticoagulant (HR, 2.
36 [95% CI, 1.
00] during the trial -5.
62], P=0.
047)] is an important predictor
.

Compared with 100±10 mg/dL, the goal of low-density lipoprotein cholesterol <70 mg/dL in patients with atherosclerotic ischemic stroke does not significantly increase the risk of ICH
.

Original source: Amarenco P, Kim JS, Labreuche J, et al.