Association between statin treatment and outcomes after acute intracerebral hemorrhage in the third intensive care bundle with blood pressure reduction in acute cerebral haemorrhage trial study

Wang X.; Ouyang M.; Chen X.; Billot L.; Li Q.; Malavera A.; Venturelli P.M.; de Silva A.; Thang N.H.; Wahab K.W.; Pandian J.D.; Wasay M.; Pontes-Neto O.M.; Abanto C.; Arauz A.; Delfino C.; Li X.; Li Y.; Xu X.; Liu Y.; Zhang M.; Anderson C.S.; Hu X.; You C.; Song L.; Ma L. · Neurotherapeutics (2026) · DOI: 10.1016/j.neurot.2026.e01045

Resumen

The relationship between statin therapy and clinical outcomes after intracerebral hemorrhage (ICH) remains uncertain. Therefore, we performed a post-hoc analysis of the third intensive care bundle with blood pressure reduction in acute cerebral haemorrhage trial study to evaluate the associations of pre-ICH and post-ICH statin use with clinical outcomes. The primary outcome was death or dependency (modified Rankin Scale [mRS] 3–6) at 6 months. Secondary outcomes included death, dependency, hematoma expansion, serious adverse events (SAEs), and cerebral hemorrhagic events. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Analysis was performed using generalized linear mixed model. We further examined whether post-ICH statin therapy modified outcomes within the care bundle group. Overall, a total of 7035 patients were included in the study. Pre-ICH (aOR 0.93, 95% CI 0.61–1.42) or post-ICH statin use (aOR 0.97, 95% CI 0.72–1.29) was not associated with death or dependency. However, pre-ICH statin use was associated with lower 6-month mortality (aOR 0.46, 95% CI 0.26–0.80) and a reduced incidence of cerebral hemorrhage (aOR 0.45, 95% CI 0.21–0.97). In stratified analyses, post-ICH statin use was associated with lower odds of 6-month mortality or disability among care bundle recipients (aOR 0.66, 95% CI 0.44–0.99; P = 0.046), with significant effect modification by intervention allocation (P for interaction = 0.019). In summary, statin therapy before or after ICH onset appeared to be safe, without increased risk of SAEs and hematoma expansion. Besides, among patients receiving the care bundle intervention, post-ICH statin use showed a potential association with improved functional outcomes. These exploratory findings require confirmation in future studies.