Statins Protect Brain in Head Trauma
By Crystal Phend, Senior Staff Writer, October 11, 2011
Action Points
Explain that seniors on a statin at the time of moderate-to-severe head trauma were 76% less likely to die in hospital although the study could not imply a direct causal effect of statins.
Note that statin users were 13% more likely to have made a good functional recovery by 12 months.
Review
Statins may make traumatic brain injury much more survivable for older adults, a national study suggested.
Seniors on a statin at the time of moderate-to-severe head trauma were 76% less likely to die in hospital (relative risk 0.24, 95% confidence interval 0.08 to 0.69), Eric B. Schneider, PhD, of Johns Hopkins, and colleagues found.
Statin users were also 13% more likely to have made a good functional recovery by 12 months (RR 1.13, 95% CI 1.01 to 1.26), the group reported in the October issue of the Journal of Trauma.
Although cardiovascular comorbidities appeared to eliminate any protective advantage, statins warrant further study as possible protective agents to be given when patients of any age present with head trauma, the researchers suggested.
After the damage from direct impact or acceleration and deceleration of the brain, secondary injury occurs from inflammatory and immune processes, the group explained.
Statins' pleiotropic effects on inflammation, thrombosis, and endothelial function may help prevent that secondary injury, although their primary role in lowering cholesterol likely has little impact, Schneider and colleagues suggested.
Animal studies have suggested a protective effect even when statins are started soon after brain injury.
"Right now there really isn't anything that can be prescribed to help people with a serious brain injury, and this is a glimmer of hope," Schneider told MedPage Today in an interview.
However, he recommended against administering the drugs for traumatic brain injury until further confirmation of benefit and safety.
Schneider's group examined outcomes through the National Study of Costs and Outcomes of Trauma database, which receives reports from 69 U.S. hospitals.
They excluded deaths within 24 hours of hospitalization and cases admitted with fixed dilated pupils indicating likely nonsurvivable injury that statins wouldn't reasonably be expected to affect. The cohort was also limited to the age group more likely to be taking statins.
Among the 523 individuals in the database 65 and older with a head injury and Abbreviated Injury Score of at least 3, statin use at the time of injury was recorded for 22%.
Death before discharge occurred among 9.1% of statin users as compared with 15.4% of nonstatin users (P=0.047), an advantage that remained significant at 76% after adjustment for other factors remained.
At three months, statin users were a nonsignificant 23% more likely to have made a good functional recovery (RR 0.77, 95% CI 0.42 to 1.41).
Although the 13% advantage at 12 months was statistically significant overall, it wasn't among statin users who had cardiovascular comorbidities (RR 1.11, 95% CI 0.82 to 1.50).
For inhospital mortality, the same pattern emerged, with a significant benefit only among those without cardiovascular comorbidities (RR 0.17, 95% CI 0.05 to 0.63).
"If statin-induced peri-injury endothelial homeostasis in fact underlies the improved outcomes seen in this and other studies, we suspect that statins may not benefit head trauma victims with significantly compromised endothelium (e.g., cardiovascular disease)," Schneider's group wrote in the paper.
They cautioned that the observational study could not imply a direct causal effect of statins, as the results could have been confounded by a "healthy user bias."
Another limitation was the lack of data on statin type, indication, dose, or duration of treatment, the group added.
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