The drugs statins, which are used to prevent cardiovascular diseases,
also guard against brain hemorrhages. This is the conclusion of most
extensive study ever carried out, which thus also rebuffs suspicions of
the opposite being true.
As well as lowering blood cholesterol, the medication statin
also acts to guard against haemorrhages. This is shown by the results of
the largest study in the world so far, which followed more than
half-a-million people being treated with statin over a decade.
"With this study we refute a concern raised by earlier studies that
treatment with statins is associated with increased risk of brain
haemorrhages. On the contrary, in a cohort of persons with no history of
blood clots or haemorrhages in the brain, we demonstrate that statin
users compared to non-users are in fact less affected by brain
haemorrhages," says postdoc and medical doctor Anette Riisgaard Ribe
from the Danish Research Unit for General Practice. She heads this major
Danish study which has been carried out in collaboration with Aarhus
University, Denmark.
In the study, which has just been published in the scientific journal EClinicalMedicine, 519,800 people were followed from the time that they began to take statins during the period 2004-2014.
The researchers followed both this group of statin users and a
control group of people who did not take the medicine, and they
investigated how many people subsequently suffered a brain haemorrhage
in each of the two groups.
In general terms, the study shows that the risk of suffering a brain
haemorrhage is between 22-35 per cent lower for people using statins
when compared with non-users after the first six months of treatment.
All participants in the study have in common that they had not
previously suffered a blood clot or haemorrhage in the brain.
The use of statins has been an oft discussed topic in medical
circles, particularly following a clinical trial in 2006 which showed
that treatment with statins was associated with a not insignificant
increased risk of brain haemorrhages. However, this applied to people
who had previously suffered blood clots or haemorrhages in the brain.
Despite not being able to mirror these findings in a number of
meta-analyses, this concern has still remained firmly in place, as Ribe
explains.
"Current clinical treatment guidelines recommend being particularly
careful when prescribing statins to patients who have had brain
haemorrhages, while the question of whether statins should also be
avoided for patients with a high risk of brain haemorrhages is debated.
So there could be medical doctors who are reluctant to treat patients
with statins due to a fear of side effects for particularly frail
patients. However, this study makes clear that the risk of brain
haemorrhages is significantly reduced after six months of treatment
among people who receive statins on the basis of other indications than
blood clots in the brain. With our study we can conclude that any
concerns are unfounded among this group of patients and that such
concerns could even be potentially harmful if they lead to doctors
having second thoughts about prescribing medicine so that the patient
does not receive the correct treatment," she says.
Due to the large scope of the study with more than half a million
statin users, Anette Riisgaard Ribe and her research colleagues have had
excellent opportunities to test the study's results. For example, it
was possible to compare each individual being treated with statins to
five non-users on the basis of age, gender and probability of being
treated. This says something about the strength of the study and the
level of certainty with which the researchers can speak. Anette
Riisgaard Ribe explains:
"In our study, those using statins and the non-users are relatively
similar. This means that a reduced risk of brain haemorrhages cannot be
explained by statin users being a 'healthier' group which the doctor is
not worried about treating with statins."
The many statin users in the study have furthermore made it possible
to study the association between treatment with statins and brain
haemorrhages at different times following the start of treatment.
"Our study is the first that is large enough to carry out these time
analyses. This possibility is particularly important when we want to
rule out that statins can actually be harmful - because it would be very
troubling if our study had shown that the risk of brain haemorrhages
was the same for users and non-users of statins just after the start of
the treatment, but subsequently increased significantly among the statin
users."
Neither do the researchers see any sign of the reduced risk of brain
haemorrhages being linked to the concurrent use of other types of
medicine for the prevention of cardiovascular diseases in the statin
group. As this is a group of patients who are often treated with several
forms of medicine at the same time, it was important for the
researchers to clarify whether the protective effect of the statins in
reality resulted from the effect of e.g. blood-pressure lowering
medications.
"However, we found the same result regardless of whether we only
studied the effect of statins among the group of patients receiving
concurrent treatment with blood-pressure lowering medications or among
those who were not receiving this treatment. We're able to reach these
conclusions with great precision precisely because the study is so
extensive," says Anette Riisgaard Ribe.
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