People who have had a haemorrhagic stroke should avoid taking statins, US researchers said in the Archives of Neurology.
They said the drugs could increase the risks of a second stroke in these patients, outweighing any other heart benefits from the drugs.
Brain areas may be indicative
"Our analysis indicates that in settings of high recurrent intracerebral haemorrhage risk, avoiding statin therapy may be preferred," Dr Brandon Westover of Massachusetts General Hospital and Harvard Medical School and colleagues wrote in their report.
That was especially true of people who had haemorrhagic strokes in the frontal, parietal, temporal, or occipital lobes, which recur more often than strokes deep in the brain.
"In survivors of lobar (intracerebral haemorrhage) without prior cardiovascular events, avoiding statins yielded a life expectancy gain of 2.2 quality-adjusted life-years compared with statin use," the authors reported.
Stroke and cardiovascular events
And for patients with lobar haemorrhagic stroke and a history of cardiovascular events, "the annual recurrence risk of myocardial infarction would have to exceed 90% to favour statin therapy," they said.
There were also benefits to avoiding statins after a deep intracerebral haemorrhage, although not as great.
The findings are based on a model developed using data from two clinical trials.
The researchers say it's not clear how statins increase the bleeding risk in these patients. It may be that low cholesterol levels increase the risk of bleeding in the brain, or that statins affect clotting factors.
In an editorial, Dr Larry Goldstein of Duke University and Durham VA Medical Centre in the US said the findings do not prove that statins increase the risk - but in the absence of high-quality clinical trial data, they may help inform decisions about which patients with heart risks will benefit from statins. - (Reuters Health, January 2011)