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Lipitor Linked to Bleeding After Stroke

Experts: Most Patients Still Benefit From Taking Lipitor
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Strokes and Statins continued...

One troubling finding was an increased risk for brain bleeding among the Lipitor-treated patients. A total of 2.3% experienced this complication during the study period, compared with 1.4% of placebo-treated patients.

In the newly published analysis of the trial data, Goldstein and colleagues looked more closely at this outcome, finding Lipitor use to be independently associated with an increased risk of brain hemorrhage.

Other identified risk factors included advanced age, male sex, and having had a previous hemorrhagic stroke.

The analysis is published in the December issue of the journal Neurology.

Who Should Take Statins?

But even in patients with these risk factors, the benefits of aggressive statin treatment may still outweigh the risks, neurologist Lee Schwamm, MD, tells WebMD.

Schwamm is director of Acute Stroke Services at Massachusetts General Hospital and a spokesman for the American Heart Association (AHA).

"The (treatment-associated) effect was small compared to these other risks," he says.

He points out that only a small percentage of strokes -- about 17% according to the AHA -- are caused by ruptured blood vessels leading to brain bleeding. The rest, called ischemic strokes, occur when blood flow to the brain is blocked, usually by  a clot.

"People who have had hemorrhagic strokes are usually at risk for ischemic stroke, so you can't say these people wouldn't benefit from this treatment," he says. "The key message is that patients with a history of hemorrhagic stroke should have a careful discussion with their doctor about the risks and benefits of this treatment."

A spokeswoman for Lipitor manufacturer Pfizer Inc. agrees.

"It is important for patients to discuss their individual risk factors with their doctor," Halit Bander, PhD, tells WebMD.

Can Cholesterol Be Too Low?

Goldstein says the latest analysis of the SPARCL results proved reassuring in several ways.

Very low LDL cholesterol levels had been linked to an increased risk for brain bleeds in several earlier, epidemiological studies.

"The hypothesis has been that we may be driving cholesterol too low with treatment," he says. "But in this study we saw no association between cholesterol lowering and brain hemorrhage."

And the data showed no evidence of an increase in brain bleeding linked to the use of blood-thinning drugs.

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