降胆固醇药物增加脑出血风险
From 自明知识
纽约（路透社 健康部）－一项新的研究显示，在最近有中风和短暂性缺血发作病史的患者中使用降胆固醇的“他汀”类药物，如立普妥（阿托伐他汀）和舒降之（辛戈他丁），可能增加脑出血风险。
本文的第一作者，Larry B. Goldstein医生对路透社说，“这项研究是对强化降胆固醇治疗对卒中预防(SPARCL)研究所收集的数据的再次统计分析，也是SPARCL研究的一部分。”
他说，SPARCL研究最大的发现是：在最近有卒中和短暂性缺血（就是一部分的脑血流暂时性的减少的情况）发作病史的患者中：使用阿托伐他汀能将再次卒中的危险降低16％。尽管如此，在一个非计划的分析中却发现，阿托伐他汀似乎可以轻微增加脑出血的风险。
最近在《神经病学》杂志上发表了一项最新的研究发现。这项研究是在分析4731名参与SPARCL研究的患者数据后得出的。参与试验的人中，67％有低灌注或缺血性卒中病史，31％有短暂性缺血发作病史，2％有出血性脑卒中病史。这项研究由Goldstein医生和他的同事们实行。Goldstein医生目前就职于北卡罗来纳州的达姆群的Duke大学医学中心。
研究报告指出：使用阿托伐他汀，脑出血风险增加68％。
Goldstein医生注意到一些观测研究的数据显示：低胆固醇水平能增加脑出血的风险。“由于他汀类药物能降低胆固醇，所以认为脑出血风险的增加是因为胆固醇的降低是合情合理的。尽管如此，我们并没有发现，胆固醇水平降低和出血风险存在相关性联系。”
根据Goldstein医生所说，来自于SPARCL研究最大的信息是阿托伐他汀治疗能降低最近有缺血性卒中和短暂性缺血发作病史的患者再次卒中的危险，而脑出血风险很小。
在先前有脑出血性卒中病史的患者中，发现脑出血的风险增加了5倍以上。其他能增加出血风险的因素包括：男性（男性脑出血风险增加79％），年龄（年龄每增加10岁，脑出血的风险增加42％）。进一步的分析显示，最后一次随访的血压在160/100 mm Hg 或者更高的患者，脑出血的风险增加6倍以上。
尽管如此，对于那些刚刚有过出血性卒中病史的患者（在本研究中有2%的组成比例的患者），阿托伐他汀治疗没有益处。
Cholesterol drugs may raise brain hemorrhage risk
NEW YORK (Reuters Health) - The use of cholesterol-lowering "statin" drugs, such as Lipitor (atorvastatin) and Zocor (simvastatin), may raise the risk of brain hemorrhage in patients who have experienced a recent stroke or a transient ischemic attack (TIA), new research suggests. Still, this risk may be outweighed by the ability of these agents to lower the overall risk of a second stroke and other serious events, such as heart attack.
"This is a secondary analysis of data collected as part of the Stroke Prevention with Aggressive Reductions in Cholesterol Levels (SPARCL) study," lead author Dr. Larry B. Goldstein told Reuters Health.
The main finding of SPARCL, he said, was that atorvastatin reduced the risk of stroke by 16 percent in patients who recently had a stroke or TIA, a condition in which blood flow to a portion of the brain is temporarily reduced. However, in an unplanned analysis, atorvastatin seemed to slightly increase the risk of brain hemorrhage.
In the present study, reported in the journal Neurology, Goldstein, from Duke University Medical Center in Durham, North Carolina, and colleagues explored this association further by analyzing data from 4,731 SPARCL participants. Sixty-seven percent of subjects had a prior low-blood-flow or "ischemic" stroke, 31 percent had a TIA, and 2 percent had a stroke caused by a brain hemorrhage.
Treatment with atorvastatin increased the risk of brain hemorrhage by 68 percent, the report indicates.
A prior hemorrhagic stroke raised the risk of brain hemorrhage by more than fivefold. Other factors that increased the risk included male gender, which raised the risk by 79 percent, and age, which elevated the risk by 42 percent for every 10 years of age. Further analysis showed that having high blood pressure -- 160/100 mm Hg or higher -- at the last study visit increased the odds of brain hemorrhage by more than sixfold.
Goldstein noted that data from observational studies have suggested that low cholesterol levels raise the risk of brain hemorrhage. "Since statins lower cholesterol, it was reasonable to think that the risk of brain hemorrhage was due to cholesterol lowering. However, we found no relationship between the level of cholesterol lowering and this risk."
According to Goldstein, the main message from SPARCL is that treatment with atorvastatin can reduce the risk of stroke in patients with a recent ischemic stroke or TIA, and the risk of brain hemorrhage is small.
However, for patients who have already had a hemorrhagic stroke, which constituted 2 percent of the study group, atorvastatin therapy did not seem to be beneficial.