Abstract Body: Introduction:
Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are severe forms of stroke with high morbidity and mortality rates. HMG-CoA reductase inhibitors commonly referred to as statins, known for their lipid-lowering abilities, also possess pleiotropic properties, including anti-inflammatory and neuroprotective effects, which may improve outcomes in hemorrhagic stroke. However, their role in ICH and SAH remains under-investigated, particularly regarding functional outcomes and survival. We aim to evaluate the impact of statin therapy on functional outcomes and survival in patients with ICH and SAH.

Methods:
This retrospective cohort study analyzed data from the American Heart Association (AHA) Get With The Guidelines (GWTG) stroke registry at a tertiary care center, including patients diagnosed with ICH or SAH between January 2008 and June 2023. Patients were categorized based on prior initiation of statin therapy: no statin, low-intensity statin, or high-intensity statin. The primary outcome was the modified Rankin Scale (mRS) score at discharge, dichotomized to good (0-2) and poor (3-6) outcomes. Due to a small sample size only mortality was assessed in the SAH group. A multivariate logistic regression model controlled for age, gender, and admission National Institutes of Health Stroke Scale (NIHSS) score.

Results:
A total of 663 patients with ICH and 159 patients with SAH were included in the analysis. In ICH patients, low-intensity statin therapy was associated with significantly higher odds of a good functional outcome (aOR 2.557, 95% CI 1.247-5.246, p = 0.0104), as was high-intensity statin therapy (aOR 2.445, 95% CI 1.313-4.552, p = 0.0048). Among SAH patients, all 39 deaths occurred in the no statin therapy group. Therefore, statin therapy was significantly associated with survival in patients with SAH.

Conclusions:
Statin therapy, particularly at high intensity, is associated with improved functional outcomes in ICH and may offer a survival benefit in SAH. These findings highlight the potential neuroprotective role of statins in hemorrhagic stroke. Further prospective studies and randomized controlled trials are needed to confirm these observations and to clarify the optimal use of statins in this patient population.