0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Statin Use and Brain Hemorrhage Real Risk or Unfounded Fear?

Marco A. Gonzalez-Castellon, MD1; Randolph S. Marshall, MD, MS1
[+] Author Affiliations
1Division of Stroke, Department of Neurology, Columbia University Medical Center, New York, New York
JAMA Neurol. 2014;71(11):1353-1354. doi:10.1001/jamaneurol.2014.2463.
Text Size: A A A
Published online

Extract

The relationship between statin use and intracerebral hemorrhage (ICH) has not been definitively established. Studies show both benefit and detriment. Statins may decrease the level of platelet aggregation and thrombogenesis and thus worsen an ICH, but they also modulate the immune system, inhibit the inflammatory process, and improve cerebral blood flow, promoting neuroprotection and tissue recovery. Despite physiological and clinical evidence on both sides of the argument, the idea that statins should be avoided whenever brain hemorrhage is involved has permeated stroke practice. Indeed, early and more recent epidemiological studies have shown a convincing inverse association between low levels of low-density lipoprotein cholesterol and the risk of hemorrhagic stroke.1 Whether this association can be applied to patients treated with statins is less clear. Is the fear of statin use for ICH justified? What is the basis on which clinicians have come to avoid statins for their hemorrhage risk, and how should this information guide our practice in light of newer evidence? Part of the confusion arises from a lack of clarity of the association between statin use and hemorrhage under different ICH etiologies. The pathophysiology may be quite different if the brain hemorrhage occurs in the setting of ischemic stroke vs after thrombolytic therapy, in hypertensive ICH, or in other conditions such as amyloid angiopathy.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,675 Views
3 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Stroke, Hemorrhagic

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Does This Patient Have a Hemorrhagic Stroke?

brightcove.createExperiences();