title: Preadmission statin use does not improve functional outcomes or prevent delayed ischemic events in patients with spontaneous subarachnoid hemorrhage.
abstract: OBJECTIVE
  To determine whether preadmission statin use in patients with spontaneous subarachnoid hemorrhage (SAH) is associated with improved functional outcomes and a lower incidence of delayed cerebral ischemic events compared with statin-naive patients with SAH.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Neurosciences intensive care unit of a tertiary care hospital.
  
  
  METHODS
  A total of 295 consecutive patients with SAH admitted between March 2006 and May 2013 who had complete medication histories; of these patients, 41 reported taking a statin prior to admission, and 254 were statin naive.
  
  
  METHODS
  All patients received clinical management for SAH according to hospital protocol for standard care that included acute statin therapy with enteral pravastatin 40 mg/day on hospital day 1 for up to 21 days.
  
  
  RESULTS
  Functional outcomes were assessed by using the modified Rankin Scale (mRS) at 14 days, 28 days, and 3 months. Delayed cerebral ischemia was assessed by using clinical evaluation and computed tomography. Patients taking statins prior to admission were more likely to have a history of diabetes mellitus, hypertension, coronary artery disease, and stroke. No significant difference in favorable neurologic outcome (mRS score 0-3) at 3 months was observed between the preadmission statin group compared with the statin-naive group (56.3% vs 72.4%, p=0.095). In multivariate logistic regression analysis, only age, severity of rupture, and coronary artery disease were less likely to predict a favorable neurologic outcome. No significant difference in the development of delayed cerebral ischemic events was observed between groups (p=0.48).
  
  
  CONCLUSIONS
  Statin use prior to admission did not improve functional outcomes or prevent delayed cerebral ischemic events in patients with SAH. Age, severity of rupture, and coronary artery disease were less likely to predict a favorable neurologic outcome at 3 months after discharge.
authors.affiliation: Department of Pharmacy, Northwestern Medicine, Chicago, Illinois.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Lizza
authors.forename: Adam
authors.initials: A
authors.lastname: Kosteva
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Maas
authors.forename: Neil F
authors.initials: NF
authors.lastname: Rosenberg
authors.forename: Eric
authors.initials: E
authors.lastname: Liotta
authors.forename: James
authors.initials: J
authors.lastname: Guth
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Levasseur-Franklin
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017035:Pravastatin / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin
keywords: functional outcome; ischemia; statin; subarachnoid hemorrhage; vasospasm