title: Cholesterol-Reducing Agents for Treatment of Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Aneurysmal hemorrhage induced cerebral vasospasm; delayed ischemic neurologic deficit (DIND), poor neurologic outcome, and mortality are major causes of mortality and morbidity. The effects of cholesterol-lowering agents in these patients remain controversial. This up-to-date systematic review and meta-analysis aimed to evaluate the efficacy of statin use in patients with aneurysmal subarachnoid hemorrhage.
  
  
  METHODS
  A systematic review of the literature conducted using electronic database searched up to September 2016 included Cochrane Central Register of Controlled Trials in the Cochrane Library, Medline, Embase, and Science Citation Index Expanded database to identify relevant studies. Data were extracted and critically appraised by 3 independent authors. In addition, fixed or random-effects model were applied to calculated pooled results based on degree of heterogeneity.
  
  
  RESULTS
  Ten randomized controlled trials were identified with 1214 patients; 587 patients received statins and there were 627 patients in the placebo group. Statins were found to significantly reduce cerebral vasospasm (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.28-0.78, P = 0.002) and DIND (OR, 0.72; 95% CI, 0.54-0.97; P = 0.03). However, there was no significant decrease in mortality (OR, 0.77; 95% CI, 0.54-1.11; P = 0.16) and poor neurologic outcome (OR, 0.96; 95% CI, 0.75-1.23; P = 0.74).
  
  
  CONCLUSIONS
  The outcome of this meta-analysis showed that use of statins in aneurysmal subarachnoid hemorrhage might have the potential to decrease occurrence of vasospasm and DIND. However, there was no benefit in the reduction of mortality and poor neurologic outcome. This is a call for further research.
authors.affiliation: Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom. Electronic address: akhigbetaiwo@yahoo.com.
authors.forename: Taiwo
authors.initials: T
authors.lastname: Akhigbe
authors.affiliation: Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom.
authors.forename: Ardalan
authors.initials: A
authors.lastname: Zolnourian
authors.affiliation: Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom.
authors.forename: Diederik
authors.initials: D
authors.lastname: Bulters
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002784:Cholesterol / Q000097:blood*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000924:Anticholesteremic Agents; D002784:Cholesterol
keywords: Meta-analysis; Statins; Subarachnoid hemorrhage