title: Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
abstract: 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.
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
authors.forename: Kai-Yuan
authors.initials: KY
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Pan
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
authors.forename: Yu-Xiang
authors.initials: YX
authors.lastname: Weng
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
authors.forename: Ren-Ya
authors.initials: RY
authors.lastname: Zhan
mesh_terms: D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D002532:Intracranial Aneurysm / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
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