Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Abstract

OBJECTIVE The efficacy of statin therapy in treating aneurysmal subarachnoid hemorrhage (SAH) remains controversial. In this meta-analysis, the authors investigated whether statin treatment significantly reduced the incidence of cerebral vasospasm and delayed neurological deficits, promoting a better outcome after aneurysmal SAH. METHODS A literature search of the PubMed, Ovid, and Cochrane Library databases was performed for randomized controlled trials (RCTs) and prospective cohort studies investigating the effect of statin treatment. The end points of cerebral vasospasm, delayed ischemic neurological deficit (DIND), delayed cerebral infarction, mortality, and favorable outcome were statistically analyzed. RESULTS Six RCTs and 2 prospective cohort studies met the eligibility criteria, and a total of 1461 patients were included. The meta-analysis demonstrated a significant decrease in the incidence of cerebral vasospasm (relative risk [RR] 0.76, 95% confidence interval [CI] 0.61-0.96) in patients treated with statins after aneurysmal SAH. However, no significant benefit was observed for DIND (RR 0.88, 95% CI 0.70-1.12), delayed cerebral infarction (RR 0.66, 95% CI 0.33-1.31), mortality (RR 0.69, 95% CI 0.39-1.24) or favorable outcome, according to assessment by the modified Rankin Scale or Glasgow Outcome Scale (RR 0.99, 95% CI 0.92-1.17). CONCLUSIONS Treatment with statins significantly decreased the occurrence of vasospasm after aneurysmal SAH. The incidence of DIND, delayed cerebral infarction, and mortality were not affected by statin treatment. Future research should focus on DIND and how statins influence DIND.

Atorvastatin Protects Against Cerebral Aneurysmal Degenerative Pathology by Promoting Endothelial Progenitor Cells (EPC) Mobilization and Attenuating Vascular Deterioration in a Rat Model

“…There are also some advantages of the use of statins in patients with ruptured cerebral aneurysms. The administration of ATR significantly protected against aneurysmal subarachnoid hemorrhage (SAH) by decreasing the occurrence of vasospasm [19]. Moreover, the administration of simvastatin can reduce post-SAH cognitive dysfunction [20].…”

Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: A randomized pilot trial of pharmaconutrition

“…Statins, acetylsalicylic acid, and selective inhibitors of non-steroidal anti-inflammatory drugs (NSAIDs) had to be avoided for 30, 60, and 90 days respectively, as they theoretically have the potential to modify the effects of the intervention. [ 56 58 75 ]…”

Dose-Dependent Effects of Statins for Patients with Aneurysmal Subarachnoid Hemorrhage: Meta-Regression Analysis

“…Multiple meta-analyses have also investigated the potential benefit of statins in aSAH but have reached differing conclusions [21][22][23][24][25][26][27]. Two important issues commonly encountered when comparing the original studies are the variable choice of statin therapy as well as different dosing strategies implemented.…”

“…A number of recent meta-analyses have broached the subject of whether statins may be beneficial in aSAH but have reached differing conclusions [21][22][23][24][25][26][27]. Our sensitivity analysis provides some insight into the discrepancies since statistical significance of the meta-regression coefficients was sensitive to exclusion of individual studies.…”