Statins for Chronic Subdural Hemorrhage: Pleiotropy and Pathophysiology
HMG-CoA reductase inhibitors, or statins, are widely used for lipid lowering to risk the risk of cardiovascular disease. Based on the suspected pleiotropic effects of statin medications, such as their anti-inflammatory and endothelial stabilization effects, trials of statin medications for non-cardiovascular indications have proliferated.
Statin medications have been tested for indications ranging from acute respiratory distress syndrome (ARDS) to chronic obstructive pulmonary disease (COPD). Statin therapy was not shown to be beneficial for these indications. So, I was pleasantly surprised to come across a JAMA Neurology publication reporting on a randomized trial of statin therapy for chronic subdural hemorrhage.
Subdural hemorrhage is a common and morbid condition in older individuals. To date, the primary treatment has been neurosurgical. Neurologists are involved in the care of these patients primarily to control seizures.
Jiang and colleagues report the results of a Phase II, randomized, placebo-controlled, double-blind, multi-center trial in which 169 patients with chronic subdural hematoma were randomized to receive atorvastatin or a placebo.1 They followed these patients for up to 24 weeks, and measured hematoma volume, rates of surgery, and clinical outcomes.
Although the size of the study population limits certainty in the results, their results were remarkably consistent across several outcomes, both radiographic and clinical: patients randomized to atorvastatin did better. Remarkably, patients randomized to atorvastatin also less frequently required surgery.
If confirmed, the results of this study speak to the pleiotropic effect of statin medications and inform our understanding of chronic subdural hemorrhage pathophysiology – perhaps further implicating inflammation and endothelial dysfunction. In addition to being clinically useful, these results underscore the value of persistence in clinical investigation.
1Jiang et al. Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients. JAMA Neurology. 2018 [E-pub ahead of print].
Neal S. Parikh, MD, earned his MD from Weill Cornell Medical College and completed residency training in neurology at the same institution. He is now an NIH T32 neuro-epidemiology and vascular neurology fellow at New York-Presbyterian Hospital/Columbia University Medical Center. He tweets @NealSParikhMD and contributes to Blogging Stroke as a blogger.