Microbleeds International Collaborative Network (MICON)
Whether statins increase the risk of intracranial hemorrhage (ICrH) after ischemic stroke (IS) in the presence of cerebral microbleeds (CMB) is uncertain. We investigated whether statins are associated the risk of IS recurrence or ICrH for patients with IS and CMB.
Pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), including 38 hospital-based prospective cohort studies from 18 countries. All patients had previous IS or transient ischemic attack, had a baseline MRI allowing CMB quantification (0/≥1/≥2/≥5/≥10) and distribution (lobar/non-lobar/mixed), registered statin use after the IS (high/moderate/low-intensity), and follow-up ≥3 months. The primary outcome was the occurrence of recurrent IS or ICrH, and secondary outcomes were IS alone or ICrH alone, during follow-up. We used Cox regression models (adjusting for age, sex, hypertension, atrial fibrillation, previous stroke, and use of antiplatelet or anticoagulant drugs) to investigate the association of statins with the outcomes.
Among 16,632 patients, 4,743 had ≥1 CMB, and a median follow-up of 1·03 years (IQR: 0·32-2·16) The adjusted hazard ratio (aHR) comparing patients with CMB and statins with those without statins was 0·68 (95% CI 0·56-0·84) for the composite outcome; 0·65 (95%CI 0·51-0·82) for IS; and 0·73 (0·46-1·15) for ICrH. Results in aHR were similar when considering anatomical distribution, number of CMB, statin intensity, or in patients without CMB.
These observational data suggest that statins were associated with a lower risk of all stroke after IS in patients with CMB, regardless of CMB anatomical distribution or burden, with no increase in the risk of ICrH.
Not applicable