Do statins improve outcomes and reduce the incidence of vasospasm after aneurysmal subarachnoid hemorrhage: a meta-analysis.
OBJECTIVE
Subarachnoid hemorrhage (SAH) is a relatively rare cause of stroke with a high rate of morbidity and mortality, primarily due to the occurrence of delayed vasospasm. To date, many therapies have been proposed to help prevent vasospasm, but very few have been proven effective. The initiation of statin therapy after SAH may be effective in reducing the incidence of vasospasm; however, the only studies that have examined this effect have been small. This meta-analysis attempted to determine whether statins reduce morbidity and mortality after aneurysmal SAH.


METHODS
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for randomized, controlled trials relating to the use of statins in SAH. Foreign language and abstract articles were included. Two independent reviewers assessed studies for eligibility, data extraction, and quality. Primary outcome was the incidence of radiographically confirmed clinical vasospasm; secondary outcomes were incidence of delayed ischemic deficits and mortality.


RESULTS
The incidence of vasospasm (relative risk [RR]=0.73; 95% CI, 0.54 to 0.99), delayed ischemic deficits (RR=0.38; 95% CI, 0.17 to 0.83), and mortality (RR=0.22; 95% CI, 0.06 to 0.82) were significantly reduced in the statin group. For these outcomes, we calculated a number needed to treat of 6.25, 5, and 6.7, respectively.


CONCLUSIONS
Initiation of statin therapy after aneurysmal SAH significantly reduces the incidence of vasospasm, delayed ischemic deficits, and mortality. This is consistent with animal research and retrospective studies and supports the routine use of statins in the care of patients with aneurysmal SAH.
Sillberg
Victoria A H
VA
Clinical Epidemiology Program, F6, Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9 Canada.
Wells
George A
GA
Perry
Jeffrey J
JJ
D002545:Brain Ischemia / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D002536:Cerebral Arteries / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D009026:Mortality / Q000639:trends; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors