The association of statin and intracerebral hemorrhage risk is controversial. We conducted this meta-analysis to assess the safety of statin by estimating the risk versus benefit in terms of cerebral hemorrhagic and ischemic events.

A total of 19 clinical studies met the inclusion criteria and were included in the meta-analysis. We calculated pooled risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. The primary endpoint was intracerebral hemorrhage. Secondary endpoints were ischemic stroke and transient ischemic attack. 

A total of 35,842 were included in this metanalysis. The risk of combined primary and secondary intracerebral hemorrhage was not significantly associated with statin (RR 1.03; 95% CI 0.85-1.08). Sensitivity analysis showed a trend toward a higher risk of secondary intracerebral hemorrhage among those who were assigned to statin treatment (OR 1.87, 95% CI .91-3.86). The risk of cerebral ischemia (stroke and transient ischemic attack) was significantly lower in subjects assigned to statin treatment (RR 0.79; 95% CI 0.61-0.87).  

The benefits of lipid-lowering therapy in the prevention of ischemic stroke greatly exceed the risk of ICH.