The use of statins in patients following ICH remains controversial;despite the demonstrated beneficial effects of statinsin preventing first-ever and recurrent ischaemic stroke, therate of prescription is variable [1], which could in part be becauseof concerns about a potentially increased risk of intracerebralhaemorrhage (ICH). Whether any increased ICHrisk might outweigh the benefit of statins is particularly controversialin patients with a previous ICH; as well as lipid lowering,statins have other (pleiotropic) actions, includingantiplatelet and anticoagulant effects. Furthermore, in boththe Stroke Prevention by Aggressive Reduction in CholesterolLevels (SPARCL) and Heart Protection Study (HPS), the benefitin reducing recurrent ischaemic stroke was offset in part byan increased risk of ICH [2–4]. Another potentially interestingeffect of statins in ICH survivors (who are at substantialrisk of post-stroke seizures) [5] is their potential to reduceepileptogenesis by several mechanisms: (i) attenuating thelink between the NMDA receptor subunit-1 and lipid rafts,which may protect against NMDA mediated excitotocitity;(ii) restoring the balance of pro-inflammatory cytokines(IL-1β, TNFα and IL-6) in favour of anti-inflammatory cytokines(IL-10); and (iii) exerting beneficial effects on endothelialdysfunction through normalizing vasomotion. Indeed,some observational studies reported a lower risk of epilepsyin older people or those with ischaemic stroke, which couldrelate to statin exposure.
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