Background: Aneurysmal subarachnoid hemorrhage (aSAH) induced cerebral vasospasm and delayed cerebral ischemia (DCI) are the major causes of morbidity and mortality in patients with aSAH. Recently, there has been growing interest in the use of statins, which raises cerebral endothelial nitric oxide synthase expression, improves endothelial function, increases cerebral blood flow and has been shown to protect against ischemia. However, the effect of statins use for patients with aSAH remain controversial with mixed results, with a latest meta-analysis demonstrating that statins have a potential benefit with regards to mortality and DCI.
Methods: All randomized, placebo-controlled trials studying the effect of statins on vasospasm, DCI, poor neurological outcomes and death in aSAH were included. Search was done primarily using Medline (PubMed), where a total of 140 studies were identified using the search terms ‘statins’ and ‘subarachnoid hemorrhage’. The search was then narrowed down to 47 items, from which 7 studies were included for the final analysis. Statistical analysis was performed using the comprehensive meta-analysis software RevMan version 5.3 to obtain the odds ratio (risk ratio) estimates and also the forest plot comparisons.
Results: In 7 studies, a total of 1052 patients were analyzed, 515 in the ‘statins’ group and 537 in the ‘placebo’ group were compared. There were no statistically significant differences between the two groups with regards to vasospasm observed with transcranial doppler (Odds ratio, 0.69 [95% CI, 0.68to 1.24]), poor neurological outcomes ( OR 0.97, [95% CI, 0.74-1.27]), and death (OR 0.74 [95% CI, 0.49-1.12])(Fig.4). A trend towards decreased risk of DCI was seen with the use of statins (OR, 0.79 [95% CI, 0.57-1.09) (Figures 1-4). The mean follow up was about 6 months.
Conclusion: Statins have no benefit in terms of mortality, cerebral ischemia, DCI or poor neurological outcomes when compared to placebo in patients with aSAH. The current study does not support the routine use of statins for all patients with aSAH.