Editors' note: Association of statin use with spontaneous intracerebral hemorrhage: A cohort study

In "Association of statin use with spontaneous intracerebral hemorrhage: A cohort study," Saliba et al. reviewed the risk of intracerebral hemorrhage (ICH) in patients in a large database who were recently started on statins and found that high-dose statin use was associated with decreased risk of ICH as compared with low-dose statin use. However, the authors noted a paradox in their data because they also found that low cholesterol levels were associated with increased risk of ICH. This protective effect of statins may be from other mechanisms besides simply lowering cholesterol. Dr. Goldstein notes that these findings add to those of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels ( SPARCL ) trial, which showed high-dose statins were beneficial for secondary stroke prevention in general, but did not provide meaningful conclusions for patients with ICH in particular, due to low numbers. Dr. Vilanilam commends the study's design, but points out that there have been conflicting data about the relationship between statin use and cerebral microbleeds, and comments that preclinical studies are needed to further clarify this relationship. Dr. Saliba et al. agree that preclinical studies and large prospective studies are needed to better assess the effect of statin use on ICH, with respect to both statin dose and ICH location. In "Association of statin use with spontaneous intracerebral hemorrhage: A cohort study," Saliba et al. reviewed the risk of intracerebral hemorrhage (ICH) in patients in a large database who were recently started on statins and found that high-dose statin use was associated with decreased risk of ICH as compared with low-dose statin use. However, the authors noted a paradox in their data because they also found that low cholesterol levels were associated with increased risk of ICH.