Evidence mapPaperPMID 38323514Full record

SynthesisJournal of the American Heart Association2024

Lipid-Lowering Therapy and Risk of Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Sylvain Bétrisey, Moa Lina Haller, Orestis Efthimiou, Alexandre Speierer, Cinzia Del Giovane, Elisavet Moutzouri, Manuel R Blum, Drahomir Aujesky, Nicolas Rodondi, Baris Gencer

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Journal of the American Heart Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 3 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Article
  5. Article
  6. Review
  7. 2025 Egyptian guidelines for the management of dyslipidemia.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2026
    Review
  8. Review
  9. Review
  10. Article
  11. Article
  12. Review
  13. Reducing LDL-Cholesterol to Very Low Levels: Sailing Between Established Benefits and Potential Risks.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2025
    Review
  14. Article
  15. Article
  16. Review
  17. Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2025
    Article
  18. Low LDL-C: Is It all Good News?Current atherosclerosis reports · 2024
    Review
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Sylvain BétriseyDepartment of General Internal Medicine, Inselspital Bern University Hospital, University of Bern Switzerland.
Moa Lina HallerDepartment of General Internal Medicine, Inselspital Bern University Hospital, University of Bern Switzerland.ORCID 0009-0006-2380-349X
Orestis EfthimiouInstitute of Primary Health Care (BIHAM) University of Bern Switzerland.ORCID 0000-0002-0955-7572
Alexandre SpeiererDepartment of General Internal Medicine, Inselspital Bern University Hospital, University of Bern Switzerland.ORCID 0000-0003-1727-4035
Cinzia Del GiovaneInstitute of Primary Health Care (BIHAM) University of Bern Switzerland.
Elisavet MoutzouriDepartment of General Internal Medicine, Inselspital Bern University Hospital, University of Bern Switzerland.ORCID 0000-0002-7713-7553
Manuel R BlumDepartment of General Internal Medicine, Inselspital Bern University Hospital, University of Bern Switzerland.ORCID 0000-0003-4638-775X
Drahomir AujeskyDepartment of General Internal Medicine, Inselspital Bern University Hospital, University of Bern Switzerland.ORCID 0000-0002-3970-2670
Nicolas RodondiDepartment of General Internal Medicine, Inselspital Bern University Hospital, University of Bern Switzerland.ORCID 0000-0001-9083-6896
Baris GencerInstitute of Primary Health Care (BIHAM) University of Bern Switzerland.ORCID 0000-0002-8954-9694

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is debate over whether statins increase risk of hemorrhagic stroke, so we assessed current evidence, including data from new statin trials and trials of nonstatin low-density lipoprotein-cholesterol (LDL-C)- and triglyceride-lowering therapies. METHODS AND

resultsWe performed a systematic review of large randomized clinical trials (≥1000 patients with ≥2 years follow-up) of LDL-C-lowering therapy (statin, ezetimibe, and PCSK-9 [proprotein convertase subtilisin/kexin type 9] inhibitor) and triglyceride-lowering therapy (omega-3 supplements and fibrate) that reported hemorrhagic stroke as an outcome. We searched MEDLINE, Embase, and Cochrane Library up to July 2, 2021 and updated a meta-analysis of cardiovascular statin trials published in 2012. Among our several subgroup analyses, we looked at difference depending on stroke status and also depending on age. We identified 37 trials for LDL-C lowering (284 301 participants) and 11 for triglyceride lowering (120 984 participants). Overall, we found a higher risk of hemorrhagic stroke for LDL-C lowering, risk ratio (RR) 1.16 (95% CI, 1.01-1.32,

conclusionsWe found evidence for a small increased risk of hemorrhagic stroke events with LDL-C-lowering therapies but no clear evidence for triglyceride-lowering therapies. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42021275363.

Indexed as

Anticholesteremic AgentsCardiovascular DiseasesHemorrhagic StrokeHydroxymethylglutaryl-CoA Reductase InhibitorsStrokeAgedCholesterol, LDLEzetimibeHumansRandomized Controlled Trials as TopicTriglyceridesAnticholesteremic AgentsCholesterol, LDLEzetimibeHydroxymethylglutaryl-CoA Reductase InhibitorsTriglycerideshemorrhagic strokeintracerebral hemorrhagelipid‐lowering therapynonstatinstatin

Identifiers

PMID38323514
PMCPMC11010101

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.