Effect of statins on functional outcome and mortality following aneurysmal subarachnoid hemorrhage – Results of a meta-analysis, metaregression and trial sequential analysis

Bohara, Sandeep; Gaonkar, Vishwa Bharathi; Garg, Kanwaljeet; Rajpal, Preet Mohinder Singh; Singh, Pankaj Kumar; Singh, Manmohan; Suri, Ashish; Chandra, Parijat; Kale, Shashank S.

doi:10.1016/j.clineuro.2021.106787

Cited by 6 publications

(5 citation statements)

References 43 publications

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“…The metaanalysis found statistically signi cant differences between the statin group and the control groups on the cerebral vasospasm rate. This nding agreed with previous published systematic reviews and meta-analyses that demonstrated the signi cant bene ts of statins' pharmacologic effect on cerebral vasospasm in animal models [29], while in human studies, they share statistical support [30][31][32][33][34][35][36] or are contradictory [37][38][39][40][41][42][43]. Here, the vasospasm meta-analysis has advantages that weigh in favor of the hypothesis, as it was performed on randomized control studies (RCTs) only and excluded non-RCTs designs.…”

Section: Discussionsupporting

confidence: 91%

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Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

Radwan

2022

Preprint

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Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a serious neurological disease and is associated with early and delayed unfavourable consequences. Vasospasm and delayed cerebral ischemia are reasonable for mortality and permanent disability. Using statin therapy may improve neurological outcomes. The aim of this systematic review is to assess the benefits of statin agents in improving the clinical outcomes in patients with aSAH. Methods: A search was done electronically using a search strategy (December 2021), combing free– text and medical subject heading (MeSH) terms in five databases: Medline, PubMed, Scopus, Web of Science, and the Cochrane library, with no restriction on language or publication date. This study protocol was registered with PROSPERO, number CRD42022296336. Main Results: nine randomized controlled studies (RCTs) are eligible and included in meta– analysis. The meta– analyses show significant effects of the statins by reduction in the incidences of vasospasm, delayed neurological ischemic deficits, and delayed cerebral ischemia. The pooled MH odds ratios were 0.55 (95% CI 0.39– 0.81), 0.71 (95% CI 0.54– 0.92) and 0.7(95% CI 0.53– 0.94), respectively. The poor outcome and mortality are not statistically different between statins and placebo. The pooled MH odds ratios were 0.97 (95% CI 0.77– 1.22) and 0.85 (95% CI 0.57– 1.26). No significant adverse effects were reported. Also, subgrouping shows that early administration of statins (within 48– 72 hours) of aSAH onset has significant benefits by decreasing the incidence rate of vasospasm, DIND, and DCI. Conclusion: The statin has a beneficial effect and is safe in patients with aSAH to avoid vasospasm and associated neurological deficits.

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Section: Discussionsupporting

confidence: 91%

“…Delayed ischemic neurological de cits (DIND) meta-analysis was agreed with most previous systematic review and metaanalysis [30,34,35,37,41,43,46]. Ours is considered the most updated meta-analysis, it includes nine RCTs (includes 1464 patients) and also.…”

Section: Discussionsupporting

confidence: 58%

Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

Radwan

2022

Preprint

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“…Second, endothelin-receptor antagonists have proven to counteract cerebral vasospasm, but without any benefit on clinical outcome, possibly as a consequence of associated adverse effects such as anemia, arterial hypotension, and respiratory failure. 138 Third, other agents with a potential beneficial effect on cerebral vasospasm and DCI include statins 139 , 140 and magnesium sulphate, 141 which, so far, are promising but need further validation. 3 , 4 Fourth, mitochondrial dysfunction is common after aSAH 67 and as outlined above, cyclosporin has been used to treat this condition in TBI, 135 but it remains to be tested in aSAH.…”

Section: Cellular and Molecular Injury Processes And The Role Of Neur...mentioning

confidence: 99%

Fine tuning of neurointensive care in aneurysmal subarachnoid hemorrhage: From one-size-fits-all towards individualized care

Wettervik

Lewén

Enblad

2023

World Neurosurgery: X

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“…Several animal studies suggested that statins improve early brain damage and reduce cerebral vasospasm after subarachnoid hemorrhage through their anti-inflammatory, anti-apoptotic, and AQP4 expression-inhibitory effects [97][98][99]. Several clinical trials showed that statins reduce cerebral vasoconstriction and DIND [100][101][102][103], and some meta-analyses also showed this finding [104][105][106]. In contrast, there are some studies that have not shown the clear efficacy of statins [107,108].…”

Section: Cerebral Aneurysm and Subarachnoid Hemorrhagementioning

confidence: 99%

Beyond Lipid-Lowering: Effects of Statins on Cardiovascular and Cerebrovascular Diseases and Cancer

et al. 2022

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The 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, also known as statins, are administered as first-line therapy for hypercholesterolemia, both as primary and secondary prevention. Besides the lipid-lowering effect, statins have been suggested to inhibit the development of cardiovascular disease through anti-inflammatory, antioxidant, vascular endothelial function-improving, plaque-stabilizing, and platelet aggregation-inhibiting effects. The preventive effect of statins on atherothrombotic stroke has been well established, but statins can influence other cerebrovascular diseases. This suggests that statins have many neuroprotective effects in addition to lowering cholesterol. Furthermore, research suggests that statins cause pro-apoptotic, growth-inhibitory, and pro-differentiation effects in various malignancies. Preclinical and clinical evidence suggests that statins inhibit tumor growth and induce apoptosis in specific cancer cell types. The pleiotropic effects of statins on cardiovascular and cerebrovascular diseases have been well established; however, the effects of statins on cancer patients have not been fully elucidated and are still controversial. This review discusses the recent evidence on the effects of statins on cardiovascular and cerebrovascular diseases and cancer. Additionally, this study describes the pharmacological action of statins, focusing on the aspect of ‘beyond lipid-lowering’.

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Effect of statins on functional outcome and mortality following aneurysmal subarachnoid hemorrhage – Results of a meta-analysis, metaregression and trial sequential analysis

Cited by 6 publications

References 43 publications

Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

Fine tuning of neurointensive care in aneurysmal subarachnoid hemorrhage: From one-size-fits-all towards individualized care

Beyond Lipid-Lowering: Effects of Statins on Cardiovascular and Cerebrovascular Diseases and Cancer

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