Evidence map›Paper›PMID 37243540›Full record

ArticleInternational journal of stroke : official journal of the International Stroke Society2023

Association of statin use and lipid levels with cerebral microbleeds and intracranial hemorrhage in patients with atrial fibrillation: A prospective cohort study.

Elisavet Moutzouri, Matthias Glutz, Nazanin Abolhassani, Martin Feller, Luise Adam, Baris Gencer, Cinzia Del Giovane, Sylvain Bétrisey, Rebecca E Paladini, Elisa Hennings and 18 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of stroke : official journal of the International Stroke Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
1.2field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors at 5 institutions in 3 countries.

Elisavet MoutzouriInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.ORCID 0000-0002-7713-7553
Matthias GlutzInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Nazanin AbolhassaniInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Martin FellerInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.ORCID 0000-0003-2519-836X
Luise AdamInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Baris GencerInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Cinzia Del GiovaneInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Sylvain BétriseyInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Rebecca E PaladiniCardiovascular Research Institute Basel, Basel University Hospital, University of Basel, Basel, Switzerland.
Elisa HenningsCardiovascular Research Institute Basel, Basel University Hospital, University of Basel, Basel, Switzerland.ORCID 0000-0003-2616-5535
Stefanie AeschbacherCardiovascular Research Institute Basel, Basel University Hospital, University of Basel, Basel, Switzerland.
Jürg H BeerDepartment of Medicine, Cantonal Hospital of Baden and Center for Molecular Cardiology, University Hospital of Zurich, Zurich, Switzerland.
Giorgio MoschovitisCardiology Division, Regional Hospital of Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.
David SeiffgeDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Gian Marco De MarchisDepartment of Neurology and Stroke Center, Basel University Hospital, University of Basel, Basel, Switzerland.
Michael CoslovskyCardiovascular Research Institute Basel, Basel University Hospital, University of Basel, Basel, Switzerland.
Tobias ReichlinDivision of Cardiology, Department of Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Giulio ConteCardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Tim SinneckerDepartment of Neurology and Stroke Center, Basel University Hospital, University of Basel, Basel, Switzerland.
Matthias SchwenkglenksEpidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
Leo H BonatiDepartment of Neurology and Stroke Center, Basel University Hospital, University of Basel, Basel, Switzerland.
Peter KastnerRoche Diagnostics GmbH, Penzberg, Germany.
Drahomir AujeskyInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Michael KühneCardiovascular Research Institute Basel, Basel University Hospital, University of Basel, Basel, Switzerland.
Stefan OsswaldCardiovascular Research Institute Basel, Basel University Hospital, University of Basel, Basel, Switzerland.
Urs FischerDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.ORCID 0000-0003-0521-4051
David ConenDivision of Cardiology, Department of Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Nicolas RodondiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
University of Bern · CHUniversity of Basel · CHEnte Ospedaliero Cantonale · CHRoche Pharma AG (Germany) · DEUniversity Hospital of Zurich · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAn increased risk of intracranial hemorrhage (ICH) associated with statins has been reported, but data on the relationship between statin use and cerebral microbleeds (CMBs) in patients with atrial fibrillation (AF), a population at high bleeding and cardiovascular risk, are lacking.

aimsTo explore the association between statin use and blood lipid levels with the prevalence and progression of CMBs in patients with AF with a particular focus on anticoagulated patients.

methodsData of Swiss-AF, a prospective cohort of patients with established AF, were analyzed. Statin use was assessed during baseline and throughout follow-up. Lipid values were measured at baseline. CMBs were assessed using magnetic resonance imagining (MRI) at baseline and at 2 years follow-up. Imaging data were centrally assessed by blinded investigators. Associations of statin use and low-density lipoprotein (LDL) levels with CMB prevalence at baseline or CMB progression (at least one additional or new CMB on follow-up MRI at 2 years compared with baseline) were assessed using logistic regression models; the association with ICH was assessed using flexible parametric survival models. Models were adjusted for hypertension, smoking, body mass index, diabetes, stroke/transient ischemic attack, coronary heart disease, antiplatelet use, anticoagulant use, and education.

resultsOf the 1693 patients with CMB data at baseline MRI (mean ± SD age 72.5 ± 8.4 years, 27.6% women, 90.1% on oral anticoagulants), 802 patients (47.4%) were statin users. The multivariable adjusted odds ratio (adjOR) for CMBs prevalence at baseline for statin users was 1.10 (95% CI = 0.83-1.45). AdjOR for 1 unit increase in LDL levels was 0.95 (95% CI = 0.82-1.10). At 2 years, 1188 patients had follow-up MRI. CMBs progression was observed in 44 (8.0%) statin users and 47 (7.4%) non-statin users. Of these patients, 64 (70.3%) developed a single new CMB, 14 (15.4%) developed 2 CMBs, and 13 developed more than 3 CMBs. The multivariable adjOR for statin users was 1.09 (95% CI = 0.66-1.80). There was no association between LDL levels and CMB progression (adjOR 1.02, 95% CI = 0.79-1.32). At follow-up 14 (1.2%) statin users had ICH versus 16 (1.3%) non-users. The age and sex adjusted hazard ratio (adjHR) was 0.75 (95% CI = 0.36-1.55). The results remained robust in sensitivity analyses excluding participants without anticoagulants.

conclusionsIn this prospective cohort of patients with AF, a population at increased hemorrhagic risk due to anticoagulation, the use of statins was not associated with an increased risk of CMBs.

Indexed as

Atrial FibrillationHydroxymethylglutaryl-CoA Reductase InhibitorsStrokeAgedAged, 80 and overAnticoagulantsCerebral HemorrhageFemaleHumansIntracranial HemorrhagesMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesRisk FactorsAnticoagulantsHydroxymethylglutaryl-CoA Reductase Inhibitorsbrain bleedbrain microbleedsCerebral hemorrhagecerebral microbleedslipid levelsstatin use

Identifiers

PMID37243540
PMCPMC10676039
OpenAlexW4378530819

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.