Statins are associated with an increased risk of haemorrhagic stroke while proprotein convertase subtilisin/kexin type 9 inhibitors are not, say researchers who have pooled the evidence from randomised controlled trials.

Although the absolute risk of haemorrhagic stroke with statins is low, the US investigators suggest proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors might be preferable for lipid lowering in patients at increased risk.

These include people with a history of TIA, ischaemic stroke or haemorrhagic stroke, they say.

The two researchers — from the University of California, Los Angeles — carried out a systematic review and meta-analysis, finding 36 eligible statin randomised controlled trials including almost 205,000 patients and five randomised controlled trials examining PCSK9 inhibitors with more than 76,000 patients.