Statins and Intracerebral Hemorrhage Collaborative Systematic Review and Meta-Analysis
Identifieur interne : 004769 ( PascalFrancis/Curation ); précédent : 004768; suivant : 004770Statins and Intracerebral Hemorrhage Collaborative Systematic Review and Meta-Analysis
Auteurs : Daniel G. Hackam [Canada] ; Mark Woodward [Australie] ; L. Kristin Newby [États-Unis] ; Deepak L. Bhatt [États-Unis] ; Mingyuan Shao [États-Unis] ; Eric E. Smith [Canada] ; Allan Donner [Canada] ; Muhammad Mamdani [Canada] ; James D. Douketis [Canada] ; Hisatomi Arima [Australie] ; John Chalmers [Australie] ; Stephen Macmahon [Australie] ; David L. Tirschwell [États-Unis] ; Bruce M. Psaty [États-Unis] ; Cheryl D. Bushnell [États-Unis] ; Maria I. Aguilar [États-Unis] ; Dan J. Capampangan [États-Unis] ; David J. Werring [Royaume-Uni] ; Paola De Rango [Italie] ; Anand Viswanathan [États-Unis] ; Nicolas Danchin [France] ; Ching-Lan Cheng [Taïwan] ; Yea-Huei Kao Yang [Taïwan] ; B. Marianne Verdel [Pays-Bas] ; Mei-Shu Lai [Taïwan] ; James Kennedy [Royaume-Uni] ; Shinichiro Uchiyama [Japon] ; Takenori Yamaguchi [Japon] ; Yasuo Ikeda [Japon] ; Marko Mrkobrada [Canada]Source :
- Circulation : (New York, N.Y.) [ 0009-7322 ] ; 2011.
Descripteurs français
- Pascal (Inist)
English descriptors
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Abstract
Background-A recent large, randomized trial suggested that statins may increase the risk of intracerebral hemorrhage. Accordingly, we systematically reviewed the association of statins with intracerebral hemorrhage in randomized and observational data. Methods and Results-We screened 17 electronic bibliographic databases to identify eligible studies and consulted with experts in the field. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals. Randomized trials, cohort studies, and case-control studies were analyzed separately. Only adjusted risk estimates were used for pooling observational data. We included published and unpublished data from 23 randomized trials and 19 observational studies. The complete data set comprised 248 391 patients and 14 784 intracerebral hemorrhages. Statins were not associated with an increased risk of intracerebral hemorrhage in randomized trials (risk ratio, 1.10; 95% confidence interval, 0.86-1.41), cohort studies (risk ratio, 0.94; 95% confidence interval, 0.81-1.10), or case-control studies (risk ratio, 0.60; 95% confidence interval, 0.41-0.88). Substantial statistical heterogeneity was evident for the case-control studies (I2=66%, P=0.01), but not for the cohort studies (I2=0%, P=0.48) or randomized trials (I2=30%, P=0.09). Sensitivity analyses by study design features, patient characteristics, or magnitude of cholesterol lowering did not materially alter the results. Conclusions-We found no evidence that statins were associated with intracerebral hemorrhage; if such a risk is present, its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs.
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Capampangan</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Mayo Clinic</s1><s2>Scottsdale, AZ</s2><s3>USA</s3><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Werring, David J" sort="Werring, David J" uniqKey="Werring D" first="David J." last="Werring">David J. Werring</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>18 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="De Rango, Paola" sort="De Rango, Paola" uniqKey="De Rango P" first="Paola" last="De Rango">Paola De Rango</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hospital S.M. Misericordia, University of Perugia</s1><s2>Perugia</s2><s3>ITA</s3><sZ>19 aut.</sZ></inist:fA14><country>Italie</country></affiliation></author><author><name sortKey="Viswanathan, Anand" sort="Viswanathan, Anand" uniqKey="Viswanathan A" first="Anand" last="Viswanathan">Anand Viswanathan</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Massachusetts General Hospital Stroke Research Center and Harvard Medical School</s1><s2>Boston</s2><s3>USA</s3><sZ>20 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Danchin, Nicolas" sort="Danchin, Nicolas" uniqKey="Danchin N" first="Nicolas" last="Danchin">Nicolas Danchin</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Hôpital Européen Georges-Pompidou, AP-HP, Université Paris-Descartes</s1><s2>Paris</s2><s3>FRA</s3><sZ>21 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Cheng, Ching Lan" sort="Cheng, Ching Lan" uniqKey="Cheng C" first="Ching-Lan" last="Cheng">Ching-Lan Cheng</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>National Cheng Kung University</s1><s2>Tainan</s2><s3>TWN</s3><sZ>22 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>Taïwan</country></affiliation></author><author><name sortKey="Kao Yang, Yea Huei" sort="Kao Yang, Yea Huei" uniqKey="Kao Yang Y" first="Yea-Huei" last="Kao Yang">Yea-Huei Kao Yang</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>National Cheng Kung University</s1><s2>Tainan</s2><s3>TWN</s3><sZ>22 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>Taïwan</country></affiliation></author><author><name sortKey="Marianne Verdel, B" sort="Marianne Verdel, B" uniqKey="Marianne Verdel B" first="B." last="Marianne Verdel">B. Marianne Verdel</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>Utrecht University</s1><s2>Utrecht</s2><s3>NLD</s3><sZ>24 aut.</sZ></inist:fA14><country>Pays-Bas</country></affiliation></author><author><name sortKey="Lai, Mei Shu" sort="Lai, Mei Shu" uniqKey="Lai M" first="Mei-Shu" last="Lai">Mei-Shu Lai</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>National Taiwan University</s1><s2>Taipei</s2><s3>TWN</s3><sZ>25 aut.</sZ></inist:fA14><country>Taïwan</country></affiliation></author><author><name sortKey="Kennedy, James" sort="Kennedy, James" uniqKey="Kennedy J" first="James" last="Kennedy">James Kennedy</name><affiliation wicri:level="1"><inist:fA14 i1="19"><s1>John Radcliffe Hospital, University of Oxford</s1><s2>Oxfordshire</s2><s3>GBR</s3><sZ>26 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Uchiyama, Shinichiro" sort="Uchiyama, Shinichiro" uniqKey="Uchiyama S" first="Shinichiro" last="Uchiyama">Shinichiro Uchiyama</name><affiliation wicri:level="1"><inist:fA14 i1="20"><s1>Tokyo Women's Medical University</s1><s2>Tokyo</s2><s3>JPN</s3><sZ>27 aut.</sZ></inist:fA14><country>Japon</country></affiliation></author><author><name sortKey="Yamaguchi, Takenori" sort="Yamaguchi, Takenori" uniqKey="Yamaguchi T" first="Takenori" last="Yamaguchi">Takenori Yamaguchi</name><affiliation wicri:level="1"><inist:fA14 i1="21"><s1>National Cardiovascular Center</s1><s2>Suita</s2><s3>JPN</s3><sZ>28 aut.</sZ></inist:fA14><country>Japon</country></affiliation></author><author><name sortKey="Ikeda, Yasuo" sort="Ikeda, Yasuo" uniqKey="Ikeda Y" first="Yasuo" last="Ikeda">Yasuo Ikeda</name><affiliation wicri:level="1"><inist:fA14 i1="22"><s1>Waseda University</s1><s2>Tokyo</s2><s3>JPN</s3><sZ>29 aut.</sZ></inist:fA14><country>Japon</country></affiliation></author><author><name sortKey="Mrkobrada, Marko" sort="Mrkobrada, Marko" uniqKey="Mrkobrada M" first="Marko" last="Mrkobrada">Marko Mrkobrada</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">12-0016071</idno><date when="2011">2011</date><idno type="stanalyst">PASCAL 12-0016071 INIST</idno><idno type="RBID">Pascal:12-0016071</idno><idno type="wicri:Area/PascalFrancis/Corpus">001740</idno><idno type="wicri:Area/PascalFrancis/Curation">004769</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Statins and Intracerebral Hemorrhage Collaborative Systematic Review and Meta-Analysis</title><author><name sortKey="Hackam, Daniel G" sort="Hackam, Daniel G" uniqKey="Hackam D" first="Daniel G." last="Hackam">Daniel G. Hackam</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>George Institute for Global Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author><author><name sortKey="Kristin Newby, L" sort="Kristin Newby, L" uniqKey="Kristin Newby L" first="L." last="Kristin Newby">L. Kristin Newby</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Duke Clinical Research Institute, Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Bhatt, Deepak L" sort="Bhatt, Deepak L" uniqKey="Bhatt D" first="Deepak L." last="Bhatt">Deepak L. Bhatt</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical, School</s1><s2>Boston, MA</s2><s3>USA</s3><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Shao, Mingyuan" sort="Shao, Mingyuan" uniqKey="Shao M" first="Mingyuan" last="Shao">Mingyuan Shao</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Cleveland Clinic</s1><s2>Cleveland, OH</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Smith, Eric E" sort="Smith, Eric E" uniqKey="Smith E" first="Eric E." last="Smith">Eric E. Smith</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Hotchkiss Brain Institute, University of Calgary</s1><s2>Calgary, AB</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Donner, Allan" sort="Donner, Allan" uniqKey="Donner A" first="Allan" last="Donner">Allan Donner</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Mamdani, Muhammad" sort="Mamdani, Muhammad" uniqKey="Mamdani M" first="Muhammad" last="Mamdani">Muhammad Mamdani</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Applied Health Research Centre, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>8 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Douketis, James D" sort="Douketis, James D" uniqKey="Douketis J" first="James D." last="Douketis">James D. Douketis</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>McMaster University</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>9 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Arima, Hisatomi" sort="Arima, Hisatomi" uniqKey="Arima H" first="Hisatomi" last="Arima">Hisatomi Arima</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>George Institute for Global Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>George Institute for Global Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>George Institute for Global Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author><author><name sortKey="Tirschwell, David L" sort="Tirschwell, David L" uniqKey="Tirschwell D" first="David L." last="Tirschwell">David L. Tirschwell</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>University of Washington</s1><s2>Seattle</s2><s3>USA</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Psaty, Bruce M" sort="Psaty, Bruce M" uniqKey="Psaty B" first="Bruce M." last="Psaty">Bruce M. Psaty</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>University of Washington</s1><s2>Seattle</s2><s3>USA</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Bushnell, Cheryl D" sort="Bushnell, Cheryl D" uniqKey="Bushnell C" first="Cheryl D." last="Bushnell">Cheryl D. Bushnell</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Wake Forest Baptist Medical Center</s1><s2>Winston-Salem, NC</s2><s3>USA</s3><sZ>15 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Aguilar, Maria I" sort="Aguilar, Maria I" uniqKey="Aguilar M" first="Maria I." last="Aguilar">Maria I. Aguilar</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Mayo Clinic</s1><s2>Scottsdale, AZ</s2><s3>USA</s3><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Capampangan, Dan J" sort="Capampangan, Dan J" uniqKey="Capampangan D" first="Dan J." last="Capampangan">Dan J. Capampangan</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Mayo Clinic</s1><s2>Scottsdale, AZ</s2><s3>USA</s3><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Werring, David J" sort="Werring, David J" uniqKey="Werring D" first="David J." last="Werring">David J. Werring</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>18 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="De Rango, Paola" sort="De Rango, Paola" uniqKey="De Rango P" first="Paola" last="De Rango">Paola De Rango</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hospital S.M. Misericordia, University of Perugia</s1><s2>Perugia</s2><s3>ITA</s3><sZ>19 aut.</sZ></inist:fA14><country>Italie</country></affiliation></author><author><name sortKey="Viswanathan, Anand" sort="Viswanathan, Anand" uniqKey="Viswanathan A" first="Anand" last="Viswanathan">Anand Viswanathan</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Massachusetts General Hospital Stroke Research Center and Harvard Medical School</s1><s2>Boston</s2><s3>USA</s3><sZ>20 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Danchin, Nicolas" sort="Danchin, Nicolas" uniqKey="Danchin N" first="Nicolas" last="Danchin">Nicolas Danchin</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Hôpital Européen Georges-Pompidou, AP-HP, Université Paris-Descartes</s1><s2>Paris</s2><s3>FRA</s3><sZ>21 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Cheng, Ching Lan" sort="Cheng, Ching Lan" uniqKey="Cheng C" first="Ching-Lan" last="Cheng">Ching-Lan Cheng</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>National Cheng Kung University</s1><s2>Tainan</s2><s3>TWN</s3><sZ>22 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>Taïwan</country></affiliation></author><author><name sortKey="Kao Yang, Yea Huei" sort="Kao Yang, Yea Huei" uniqKey="Kao Yang Y" first="Yea-Huei" last="Kao Yang">Yea-Huei Kao Yang</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>National Cheng Kung University</s1><s2>Tainan</s2><s3>TWN</s3><sZ>22 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>Taïwan</country></affiliation></author><author><name sortKey="Marianne Verdel, B" sort="Marianne Verdel, B" uniqKey="Marianne Verdel B" first="B." last="Marianne Verdel">B. Marianne Verdel</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>Utrecht University</s1><s2>Utrecht</s2><s3>NLD</s3><sZ>24 aut.</sZ></inist:fA14><country>Pays-Bas</country></affiliation></author><author><name sortKey="Lai, Mei Shu" sort="Lai, Mei Shu" uniqKey="Lai M" first="Mei-Shu" last="Lai">Mei-Shu Lai</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>National Taiwan University</s1><s2>Taipei</s2><s3>TWN</s3><sZ>25 aut.</sZ></inist:fA14><country>Taïwan</country></affiliation></author><author><name sortKey="Kennedy, James" sort="Kennedy, James" uniqKey="Kennedy J" first="James" last="Kennedy">James Kennedy</name><affiliation wicri:level="1"><inist:fA14 i1="19"><s1>John Radcliffe Hospital, University of Oxford</s1><s2>Oxfordshire</s2><s3>GBR</s3><sZ>26 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Uchiyama, Shinichiro" sort="Uchiyama, Shinichiro" uniqKey="Uchiyama S" first="Shinichiro" last="Uchiyama">Shinichiro Uchiyama</name><affiliation wicri:level="1"><inist:fA14 i1="20"><s1>Tokyo Women's Medical University</s1><s2>Tokyo</s2><s3>JPN</s3><sZ>27 aut.</sZ></inist:fA14><country>Japon</country></affiliation></author><author><name sortKey="Yamaguchi, Takenori" sort="Yamaguchi, Takenori" uniqKey="Yamaguchi T" first="Takenori" last="Yamaguchi">Takenori Yamaguchi</name><affiliation wicri:level="1"><inist:fA14 i1="21"><s1>National Cardiovascular Center</s1><s2>Suita</s2><s3>JPN</s3><sZ>28 aut.</sZ></inist:fA14><country>Japon</country></affiliation></author><author><name sortKey="Ikeda, Yasuo" sort="Ikeda, Yasuo" uniqKey="Ikeda Y" first="Yasuo" last="Ikeda">Yasuo Ikeda</name><affiliation wicri:level="1"><inist:fA14 i1="22"><s1>Waseda University</s1><s2>Tokyo</s2><s3>JPN</s3><sZ>29 aut.</sZ></inist:fA14><country>Japon</country></affiliation></author><author><name sortKey="Mrkobrada, Marko" sort="Mrkobrada, Marko" uniqKey="Mrkobrada M" first="Marko" last="Mrkobrada">Marko Mrkobrada</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author></analytic><series><title level="j" type="main">Circulation : (New York, N.Y.)</title><title level="j" type="abbreviated">Circulation : (N. Y. N.Y.)</title><idno type="ISSN">0009-7322</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Circulation : (New York, N.Y.)</title><title level="j" type="abbreviated">Circulation : (N. Y. N.Y.)</title><idno type="ISSN">0009-7322</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antilipemic agent</term><term>Cardiovascular disease</term><term>Cerebral hemorrhage</term><term>Cerebrovascular disease</term><term>Statin derivative</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Hémorragie cérébrale</term><term>Pathologie cérébrovasculaire</term><term>Pathologie de l'appareil circulatoire</term><term>Dérivé de la statine</term><term>Hypolipémiant</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background-A recent large, randomized trial suggested that statins may increase the risk of intracerebral hemorrhage. Accordingly, we systematically reviewed the association of statins with intracerebral hemorrhage in randomized and observational data. Methods and Results-We screened 17 electronic bibliographic databases to identify eligible studies and consulted with experts in the field. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals. Randomized trials, cohort studies, and case-control studies were analyzed separately. Only adjusted risk estimates were used for pooling observational data. We included published and unpublished data from 23 randomized trials and 19 observational studies. The complete data set comprised 248 391 patients and 14 784 intracerebral hemorrhages. Statins were not associated with an increased risk of intracerebral hemorrhage in randomized trials (risk ratio, 1.10; 95% confidence interval, 0.86-1.41), cohort studies (risk ratio, 0.94; 95% confidence interval, 0.81-1.10), or case-control studies (risk ratio, 0.60; 95% confidence interval, 0.41-0.88). Substantial statistical heterogeneity was evident for the case-control studies (I<sup>2</sup>=66%, P=0.01), but not for the cohort studies (I<sup>2</sup>=0%, P=0.48) or randomized trials (I<sup>2</sup>=30%, P=0.09). Sensitivity analyses by study design features, patient characteristics, or magnitude of cholesterol lowering did not materially alter the results. Conclusions-We found no evidence that statins were associated with intracerebral hemorrhage; if such a risk is present, its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0009-7322</s0></fA01><fA02 i1="01"><s0>CIRCAZ</s0></fA02><fA03 i2="1"><s0>Circulation : (N. Y. N.Y.)</s0></fA03><fA05><s2>124</s2></fA05><fA06><s2>20</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Statins and Intracerebral Hemorrhage Collaborative Systematic Review and Meta-Analysis</s1></fA08><fA11 i1="01" i2="1"><s1>HACKAM (Daniel G.)</s1></fA11><fA11 i1="02" i2="1"><s1>WOODWARD (Mark)</s1></fA11><fA11 i1="03" i2="1"><s1>KRISTIN NEWBY (L.)</s1></fA11><fA11 i1="04" i2="1"><s1>BHATT (Deepak L.)</s1></fA11><fA11 i1="05" i2="1"><s1>SHAO (Mingyuan)</s1></fA11><fA11 i1="06" i2="1"><s1>SMITH (Eric E.)</s1></fA11><fA11 i1="07" i2="1"><s1>DONNER (Allan)</s1></fA11><fA11 i1="08" i2="1"><s1>MAMDANI (Muhammad)</s1></fA11><fA11 i1="09" i2="1"><s1>DOUKETIS (James D.)</s1></fA11><fA11 i1="10" i2="1"><s1>ARIMA (Hisatomi)</s1></fA11><fA11 i1="11" i2="1"><s1>CHALMERS (John)</s1></fA11><fA11 i1="12" i2="1"><s1>MACMAHON (Stephen)</s1></fA11><fA11 i1="13" i2="1"><s1>TIRSCHWELL (David L.)</s1></fA11><fA11 i1="14" i2="1"><s1>PSATY (Bruce M.)</s1></fA11><fA11 i1="15" i2="1"><s1>BUSHNELL (Cheryl D.)</s1></fA11><fA11 i1="16" i2="1"><s1>AGUILAR (Maria I.)</s1></fA11><fA11 i1="17" i2="1"><s1>CAPAMPANGAN (Dan J.)</s1></fA11><fA11 i1="18" i2="1"><s1>WERRING (David J.)</s1></fA11><fA11 i1="19" i2="1"><s1>DE RANGO (Paola)</s1></fA11><fA11 i1="20" i2="1"><s1>VISWANATHAN (Anand)</s1></fA11><fA11 i1="21" i2="1"><s1>DANCHIN (Nicolas)</s1></fA11><fA11 i1="22" i2="1"><s1>CHENG (Ching-Lan)</s1></fA11><fA11 i1="23" i2="1"><s1>KAO YANG (Yea-Huei)</s1></fA11><fA11 i1="24" i2="1"><s1>MARIANNE VERDEL (B.)</s1></fA11><fA11 i1="25" i2="1"><s1>LAI (Mei-Shu)</s1></fA11><fA11 i1="26" i2="1"><s1>KENNEDY (James)</s1></fA11><fA11 i1="27" i2="1"><s1>UCHIYAMA (Shinichiro)</s1></fA11><fA11 i1="28" i2="1"><s1>YAMAGUCHI (Takenori)</s1></fA11><fA11 i1="29" i2="1"><s1>IKEDA (Yasuo)</s1></fA11><fA11 i1="30" i2="1"><s1>MRKOBRADA (Marko)</s1></fA11><fA14 i1="01"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ><sZ>30 aut.</sZ></fA14><fA14 i1="02"><s1>George Institute for Global Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ></fA14><fA14 i1="03"><s1>Duke Clinical Research Institute, Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>3 aut.</sZ></fA14><fA14 i1="04"><s1>VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical, School</s1><s2>Boston, MA</s2><s3>USA</s3><sZ>4 aut.</sZ></fA14><fA14 i1="05"><s1>Cleveland Clinic</s1><s2>Cleveland, OH</s2><s3>USA</s3><sZ>5 aut.</sZ></fA14><fA14 i1="06"><s1>Hotchkiss Brain Institute, University of Calgary</s1><s2>Calgary, AB</s2><s3>CAN</s3><sZ>6 aut.</sZ></fA14><fA14 i1="07"><s1>Applied Health Research Centre, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>8 aut.</sZ></fA14><fA14 i1="08"><s1>McMaster University</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>9 aut.</sZ></fA14><fA14 i1="09"><s1>University of Washington</s1><s2>Seattle</s2><s3>USA</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="10"><s1>Wake Forest Baptist Medical Center</s1><s2>Winston-Salem, NC</s2><s3>USA</s3><sZ>15 aut.</sZ></fA14><fA14 i1="11"><s1>Mayo Clinic</s1><s2>Scottsdale, AZ</s2><s3>USA</s3><sZ>16 aut.</sZ><sZ>17 aut.</sZ></fA14><fA14 i1="12"><s1>UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>18 aut.</sZ></fA14><fA14 i1="13"><s1>Hospital S.M. Misericordia, University of Perugia</s1><s2>Perugia</s2><s3>ITA</s3><sZ>19 aut.</sZ></fA14><fA14 i1="14"><s1>Massachusetts General Hospital Stroke Research Center and Harvard Medical School</s1><s2>Boston</s2><s3>USA</s3><sZ>20 aut.</sZ></fA14><fA14 i1="15"><s1>Hôpital Européen Georges-Pompidou, AP-HP, Université Paris-Descartes</s1><s2>Paris</s2><s3>FRA</s3><sZ>21 aut.</sZ></fA14><fA14 i1="16"><s1>National Cheng Kung University</s1><s2>Tainan</s2><s3>TWN</s3><sZ>22 aut.</sZ><sZ>23 aut.</sZ></fA14><fA14 i1="17"><s1>Utrecht University</s1><s2>Utrecht</s2><s3>NLD</s3><sZ>24 aut.</sZ></fA14><fA14 i1="18"><s1>National Taiwan University</s1><s2>Taipei</s2><s3>TWN</s3><sZ>25 aut.</sZ></fA14><fA14 i1="19"><s1>John Radcliffe Hospital, University of Oxford</s1><s2>Oxfordshire</s2><s3>GBR</s3><sZ>26 aut.</sZ></fA14><fA14 i1="20"><s1>Tokyo Women's Medical University</s1><s2>Tokyo</s2><s3>JPN</s3><sZ>27 aut.</sZ></fA14><fA14 i1="21"><s1>National Cardiovascular Center</s1><s2>Suita</s2><s3>JPN</s3><sZ>28 aut.</sZ></fA14><fA14 i1="22"><s1>Waseda University</s1><s2>Tokyo</s2><s3>JPN</s3><sZ>29 aut.</sZ></fA14><fA20><s1>2233-2242</s1></fA20><fA21><s1>2011</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>5907</s2><s5>354000505653660090</s5></fA43><fA44><s0>0000</s0><s1>© 2012 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>49 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>12-0016071</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Circulation : (New York, N.Y.)</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>Background-A recent large, randomized trial suggested that statins may increase the risk of intracerebral hemorrhage. Accordingly, we systematically reviewed the association of statins with intracerebral hemorrhage in randomized and observational data. Methods and Results-We screened 17 electronic bibliographic databases to identify eligible studies and consulted with experts in the field. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals. Randomized trials, cohort studies, and case-control studies were analyzed separately. Only adjusted risk estimates were used for pooling observational data. We included published and unpublished data from 23 randomized trials and 19 observational studies. The complete data set comprised 248 391 patients and 14 784 intracerebral hemorrhages. Statins were not associated with an increased risk of intracerebral hemorrhage in randomized trials (risk ratio, 1.10; 95% confidence interval, 0.86-1.41), cohort studies (risk ratio, 0.94; 95% confidence interval, 0.81-1.10), or case-control studies (risk ratio, 0.60; 95% confidence interval, 0.41-0.88). Substantial statistical heterogeneity was evident for the case-control studies (I<sup>2</sup>=66%, P=0.01), but not for the cohort studies (I<sup>2</sup>=0%, P=0.48) or randomized trials (I<sup>2</sup>=30%, P=0.09). Sensitivity analyses by study design features, patient characteristics, or magnitude of cholesterol lowering did not materially alter the results. Conclusions-We found no evidence that statins were associated with intracerebral hemorrhage; if such a risk is present, its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs.</s0></fC01><fC02 i1="01" i2="X"><s0>002B12B03</s0></fC02><fC02 i1="02" i2="X"><s0>002B24F02</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Hémorragie cérébrale</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Cerebral hemorrhage</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Hemorragia cerebral</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Pathologie cérébrovasculaire</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Cerebrovascular disease</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Vaso sanguíneo encéfalo patología</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Pathologie de l'appareil circulatoire</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Dérivé de la statine</s0><s2>NK</s2><s2>FR</s2><s5>09</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Statin derivative</s0><s2>NK</s2><s2>FR</s2><s5>09</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Statina derivado</s0><s2>NK</s2><s2>FR</s2><s5>09</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Hypolipémiant</s0><s5>78</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Antilipemic agent</s0><s5>78</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Hipolipemiante</s0><s5>78</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Pathologie de l'encéphale</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Pathologie du système nerveux central</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie des vaisseaux sanguins</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Vascular disease</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Vaso sanguíneo patología</s0><s5>40</s5></fC07><fN21><s1>002</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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