Statins, low cholesterol, and hemorrhagic stroke

Does low serum cholesterol trigger intracerebral hemorrhage? Such a link was first suggested by early epidemiologic studies, though this apparent relationship has appeared weaker in more recent prospective studies.1 But even if convincingly demonstrated by observational studies, does low cholesterol truly cause hemorrhagic stroke, or is it merely a marker or epiphenomenon of a hemorrhage-prone individual? Trials of cholesterol-lowering agents could potentially settle the causality question, but have also not yielded a clear-cut verdict. Recent studies of statin medications in patients with coronary artery disease have failed to reveal an increased risk of hemorrhagic stroke.2 One could argue, however, that since these studies were performed in patients with coronary heart disease, their interpretation may be limited. They were mainly conducted with middle-aged persons, while the population most at risk for stroke is older. Persons in these studies may also have been more likely to succumb to coronary disease and less likely to develop stroke at an older …