Association between statin treatment and outcomes after acute intracerebral hemorrhage in the third intensive care bundle with blood pressure reduction in acute cerebral haemorrhage trial study

The relationship between statin therapy and clinical outcomes after intracerebral hemorrhage (ICH) remains uncertain. Therefore, we performed a post-hoc analysis of the third intensive care bundle with blood pressure reduction in acute cerebral haemorrhage trial study to evaluate the associations of pre-ICH and post-ICH statin use with clinical outcomes. The primary outcome was death or dependency (modified Rankin Scale [mRS] 3–6) at 6 months. Secondary outcomes included death, dependency, hematoma expansion, serious adverse events (SAEs), and cerebral hemorrhagic events. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Analysis was performed using generalized linear mixed model. We further examined whether post-ICH statin therapy modified outcomes within the care bundle group. Overall, a total of 7035 patients were included in the study. Pre-ICH (aOR 0.93, 95% CI 0.61–1.42) or post-ICH statin use (aOR 0.97, 95% CI 0.72–1.29) was not associated with death or dependency. However, pre-ICH statin use was associated with lower 6-month mortality (aOR 0.46, 95% CI 0.26–0.80) and a reduced incidence of cerebral hemorrhage (aOR 0.45, 95% CI 0.21–0.97). In stratified analyses, post-ICH statin use was associated with lower odds of 6-month mortality or disability among care bundle recipients (aOR 0.66, 95% CI 0.44–0.99; P=0.046), with significant effect modification by intervention allocation (P for interaction=0.019). In summary, statin therapy before or after ICH onset appeared to be safe, without increased risk of SAEs and hematoma expansion. Besides, among patients receiving the care bundle intervention, post-ICH statin use showed a potential association with improved functional outcomes. These exploratory findings require confirmation in future studies.