title: Cholesterol-reducing agents for aneurysmal subarachnoid haemorrhage.
abstract: BACKGROUND
  Cerebral vasospasm and related delayed ischaemic deficits (DIDs) occur in about 17% to 40% of patients with aneurysmal subarachnoid haemorrhage (SAH) and lead to a poor outcome. Cholesterol-reducing agents might improve unfavourable outcomes.
  
  
  OBJECTIVE
  To assess the effects of cholesterol-reducing agents for improving outcomes in patients with aneurysmal SAH.
  
  
  METHODS
  We searched the Cochrane Stroke Group Trials Register (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), MEDLINE (1948 to May 2012) and EMBASE (1980 to May 2012). We also searched three Chinese databases: SinoMed, CNKI and VIP (May 2012). In an effort to identify further published, ongoing and unpublished trials we searched relevant clinical trials and research registers (May 2012), contacted pharmaceutical companies and investigators known to be involved in previous trials and screened the reference lists of all relevant articles identified.
  
  
  METHODS
  We included randomised controlled trials (RCTs) that compared cholesterol-reducing agents with control or placebo treatment in participants with aneurysmal SAH.
  
  
  METHODS
  Two review authors independently applied the inclusion criteria, reviewed the relevant trials and extracted data. We did not perform meta-analysis as we only included one RCT in the review.
  
  
  RESULTS
  We included one study in which 39 patients received either simvastatin (80 mg daily; n = 19) or placebo (n = 20) for 14 days. The incidence of DIDs (secondary outcome) was 26% (5/19) in the simvastatin group versus 60% (12/20) in the placebo group (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.19 to 1.01, P = 0.05). This means that, in this study, simvastatin had no effect on DIDs. Two patients in the simvastatin group and one patient in the placebo group had elevated levels of aspartate transaminase or alanine transaminase. One patient in the simvastatin group had a raised creatine phosphokinase. There were no results from this trial for the primary outcome of death or dependency at six months.
  
  
  CONCLUSIONS
  We cannot draw any conclusions about the effectiveness and safety of lowering cholesterol in aneurysmal SAH because of insufficient reliable evidence from only one small trial. More RCTs are needed.
authors: Department of Neurology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China. zhaobine@163.net.
authors: Zhou
authors: Z
authors: Liu
authors: Lingying
authors: L
authors: Liu
authors: Zhijian
authors: Z
authors: Zhang
authors: Zuhui
authors: Z
authors: Chen
authors: Bin
authors: B
authors: Zhao
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016032:Randomized Controlled Trials as Topic; D019821:Simvastatin / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D019821:Simvastatin
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