Hackam DG et al. – Statin exposure following ischemic stroke was not associated with intracerebral hemorrhage (ICH).

• Retrospective propensity–matched cohort study with accrual from July 1, 1994, to March 31, 2008.
• A total of 17 872 patients aged 66 years and older who initiated statin therapy following acute ischemic stroke and were followed for a median of 4.2 years (interquartile range, 2.4–5.0 years).
• To enhance causal inference, the conducted several tests of specificity to exclude healthy user bias in this sample.
• Hospitalization or emergency department visit for ICH defined using validated diagnosis coding.

• Overall, 213 episodes of ICH occurred.
• In the primary analysis comparing statin users with nonusers, the authors found no association between statins and ICH (hazard ratio = 0.87; 95% confidence interval, 0.65–1.17).
• Subgroup and dose–response analyses yielded similar results.
• In tests of specificity, statin therapy was not associated with bone mineral density testing, vitamin D or B12 screening, gastrointestinal endoscopy, or elective knee arthroplasty, suggesting that results were not due to healthy user bias or differences in quality of care.