Statin Use and Risk of Intracerebral Hemorrhage in Chinese Population: a Target Trial Emulation Study

Purpose: Statin therapy has been shown to prevent major vascular events in a wide range of individuals, but the risk of intracerebral hemorrhage (ICH) from statin use is unclear. We aimed to determine the ICH risk since statin initiation for older patients. Methods: Based on 2011-2020 year data from the Yinzhou Regional Health Care Database, patients aged 50 years or older who have no history of ICH and statin use were included in the framework of target trial emulation, and then were categorized as statin initiators and non-initiators according to their initial statin assignment during 3-month recruitment periods. The statin initiators and non-initiators in each emulated trials were matched by using propensity score and then were stacked together. Cox proportional hazards model was used to estimate the association between ICH risk and statin treatment. Results: With a median follow-up of 7.75 (interquartile range 6.75-8.75) years, 37,659 statins initiators and their 1:1 matched non-initiators were analysed where the hazard ratio of ICH between statin initiators and non-initiators were 1.09 (95% confidence interval: 0.92–1.29). The results are consistent across several subgroups and sensitivity analyses. Conclusions: no association was found between ICH risk and statin use among older patients without prior ICH, suggesting no need to avoid potential statin prescribing due to concerns of evaluated ICH risk.