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.
Keywords: CI = confidence interval; DIND = delayed ischemic neurological deficit; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; HDS-SAH = High-Dose Simvastatin for Aneurysmal Subarachnoid Hemorrhage; HHH = hypertension, hypervolemia, and hemodilution; M-H = Mantel-Haenszel; RCT = randomized controlled trial; RR = relative risk; SAH = subarachnoid hemorrhage; STASH = Simvastatin in Aneurysmal Subarachnoid Hemorrhage; TCD = transcranial Doppler; WFNS = World Federation of Neurosurgical Societies; aneurysm; delayed ischemic neurological deficit; mRS = modified Rankin Scale; meta-analysis; statin; subarachnoid hemorrhage; vascular disorders; vasospasm.