Abstract 12840: The Risk of Hemorrhagic Stroke Among Various Statins Carrying Intensive LDL-Lowering Capability in Asians

Background: Although high-intensity statin (HIS) is recommended in modern lipid guidelines, hemorrhagic stroke (HS) is one of the concerns in Asia because HIS was reported to increase the risk of intracerebral hemorrhage. Whether the HS risk is different among different high potency statins was unknown. Methods and Results: We screened the database of the Taiwan National Health Insurance from January 2013 to December 2018. Adults (≥ 18 years old) who received pitavastatin 2-4 mg/d plus ezetimibe 10 mg/d (combination group) and those who received atorvastatin 40 mg/day or rosuvastatin 20 mg/day (HIS group) for any reason were enrolled for further analysis. The primary endpoint was HS. We also assessed the differences of a composite safety outcome which included hospitalization for drug-related hepatitis or myopathy and new onset diabetes. All censored subjects were follow-up till December 2019. After 1:10 propensity matching, 41437 patients were included (37670 with HIS and 3767 with combination group). After median follow-up for 3.05 ± 1.66 years, HS occurred in 1.29% and multivariable analysis showed subjects in combination group had lower rate of HS than those in HIS group (combination vs. HIS, adjusted HR: 0.650, 95% CI: 0.443-0.953). Moreover, pre-specified subgroup analysis showed similar results in those with previous history of HS or ischemic stroke as whole population. In composite safety endpoint, there was no difference between these two groups (combination vs HIS, adjusted HR: 0.910, 95% CI: 0.809-0.953). Conclusions: Our study showed Asian general population with pitavastatin plus ezetimibe had less HS during follow-up comparing to those having HIS. These results suggested that pitavastatin plus ezetimibe was a favorable choice in Asian population who needed strict lipid control but with concern of HS.