TY - JOUR
T1 - Association between Beta-Blocker or Statin Drug Use and the Risk of Hemorrhage from Cerebral Cavernous Malformations
AU - Zuurbier, Susanna M.
AU - Hickman, Charlotte R.
AU - Rinkel, Leon A.
AU - Berg, Rebecca
AU - Sure, Ulrich
AU - Al-Shahi Salman, Rustam
N1 - Funding Information: Dr Zuurbier reports grant from Remmert Adriaan Laan Foundation and the Amsterdam Brain and Cognition, during the conduct of the study. No disclosures relevant to this article for C.R. Hickman, Drs Rinkel, Berg, and Sure. Dr Al-Shahi Salman reports collaboration with the Mario Negri Institue for Pharmacological Research for other services and grants from the Medical Research Council, the Chief Scientist Office of the Scottish Government, and The Stroke Association during the conduct of the study; and consultancy fees from BiovelocITA and Recursion Pharmaceuticals, Inc, paid to the University of Edinburgh, outside the submitted work. This work was supported by the Medical Research Council (clinical training fellowship G84/5176, clinician scientist fellowship G108/613, and senior clinical fellowship G1002605). Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: We aimed to determine the association between beta-blocker or statin drug use and the future risk of symptomatic intracranial hemorrhage or persistent/progressive focal neurological deficit from cerebral cavernous malformations (CCM). Methods: The population-based Scottish Audit of Intracranial Vascular Malformations prospectively identified adults resident in Scotland first diagnosed with CCM during 1999 to 2003 or 2006 to 2010. We compared the association between beta-blocker or statin drug use after first presentation and the occurrence of new intracranial hemorrhage or persistent/progressive focal neurological deficit due to CCM for up to 15 years of prospective follow-up. We confirmed proportional hazards and used survival analysis with multivariable adjustment for age, intracranial hemorrhage at CCM presentation, and brain stem CCM location. Results: Sixty-three (21%) of 300 adults used beta-blockers (27/63 [43%] used propranolol), and 73 (24%) used statin drugs over 3634 person-years of follow-up. At baseline, the only statistically significant imbalances in prespecified potential confounders were age by statin use and intracranial hemorrhage at presentation by beta-blocker use. Beta-blocker use was associated with a lower risk of new intracranial hemorrhage or persistent/progressive focal neurological deficit (adjusted hazard ratio, 0.09 [95% CI, 0.01-0.66]; P=0.018). Statin use was associated with a nonsignificant lower risk of intracranial hemorrhage or persistent/progressive focal neurological deficit (adjusted hazard ratio, 0.37 [95% CI, 0.01-1.07]; P=0.067). Conclusions: Beta-blocker, but not statin, use was associated with a lower risk of intracranial hemorrhage or persistent/progressive focal neurological deficit in patients with CCM.
AB - Background: We aimed to determine the association between beta-blocker or statin drug use and the future risk of symptomatic intracranial hemorrhage or persistent/progressive focal neurological deficit from cerebral cavernous malformations (CCM). Methods: The population-based Scottish Audit of Intracranial Vascular Malformations prospectively identified adults resident in Scotland first diagnosed with CCM during 1999 to 2003 or 2006 to 2010. We compared the association between beta-blocker or statin drug use after first presentation and the occurrence of new intracranial hemorrhage or persistent/progressive focal neurological deficit due to CCM for up to 15 years of prospective follow-up. We confirmed proportional hazards and used survival analysis with multivariable adjustment for age, intracranial hemorrhage at CCM presentation, and brain stem CCM location. Results: Sixty-three (21%) of 300 adults used beta-blockers (27/63 [43%] used propranolol), and 73 (24%) used statin drugs over 3634 person-years of follow-up. At baseline, the only statistically significant imbalances in prespecified potential confounders were age by statin use and intracranial hemorrhage at presentation by beta-blocker use. Beta-blocker use was associated with a lower risk of new intracranial hemorrhage or persistent/progressive focal neurological deficit (adjusted hazard ratio, 0.09 [95% CI, 0.01-0.66]; P=0.018). Statin use was associated with a nonsignificant lower risk of intracranial hemorrhage or persistent/progressive focal neurological deficit (adjusted hazard ratio, 0.37 [95% CI, 0.01-1.07]; P=0.067). Conclusions: Beta-blocker, but not statin, use was associated with a lower risk of intracranial hemorrhage or persistent/progressive focal neurological deficit in patients with CCM.
KW - adrenergic beta-antagonists
KW - cerebral hemorrhage
KW - hemangioma, cavernous, central nervous system
KW - hydroxymethylglutaryl-CoA reductase inhibitors
KW - secondary prevention
UR - http://www.scopus.com/inward/record.url?scp=85134326695&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/STROKEAHA.121.037009
DO - https://doi.org/10.1161/STROKEAHA.121.037009
M3 - Article
C2 - 35410492
SN - 0039-2499
VL - 53
SP - 2521
EP - 2527
JO - Stroke
JF - Stroke
IS - 8
ER -