Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Abstract

AIm:The role of statins for treating aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. In this study, the relevance of different end points was evaluated in order to clarify the action and efficacy of statins. mAterIAl and methOds: A systematic literature retrieval was carried out to obtain randomized controlled trials (RCTs) from before March 2013 on the use of statins for aSAH. Data extraction and quality evaluation of the studies were performed by 2 investigators. A meta-analysis was performed using Review Manager (RevMan) software version 5.2.3. results:Seven randomized controlled trials comprising 347 patients that met the inclusion criteria were included in this meta-analysis. Results showed that, in aSAH, statins did not reduce vasospasm on transcranial Doppler (RR=0.80; 95% CI, 0.53-1.21; p=0.29) or improve outcomes (RR=0.92; 95% CI, 0.71-1.20; p=0.54). However, statins were able to decrease delayed ischemic neurological deficits (RR=0.56; 95% CI, 0.41-0.75; p=0.0001) and mortality (RR=0.54; 95% CI, 0.32-0.91; p=0.02) compared with placebo.COnClusIOn: Acute statin treatment might not be a good choice for cerebral vasospasm after aSAH. Further large-scale, well-designed RCTs on this topic are still needed. BulGulAr: Bu meta analize çalışmaya alma kriterlerini karşılayan 347 hastalık yedi randomize kontrollü çalışma dahil edilmiştir. Sonuçlar aSAK durumunda statinlerin transkraniyal Doppler'de vazospazmı azaltmadığını (RR=0,80; %95 GA, 0,21; p=0,29) veya sonuçları daha iyi hale getirmediğini (RR=0,92; %95CI, 0,20; p=0,54) göstermiştir. Ancak statinler plaseboyla karşılaştırıldığında gecikmiş iskemik nörolojik defisitleri (RR=0,56; %95 GA, 0,41-0,75; p=0,0001) ve mortaliteyi (RR=0,54; %95 GA, 0,32-0,91; p=0,02) azaltmıştır. sOnuÇ: Akut statin tedavisi aSAK sonrasında serebral vazospazm için iyi bir tercih olmayabilir. Bu konuda daha büyük ölçekli ve iyi tasarlanmış randomize kontrollü çalışmalar gereklidir.

Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

“…This finding is contradictory to 5 previous meta-studies and consistent with 2 meta-analyses previously published. 16,17,33,34,36,41,48 The results regarding the secondary outcomes were disappointing. We found no evidence that statin treatment can improve DIND or delayed cerebral infarction.…”

“…5,10,18,37,42,44 Meta-analyses have also produced inconsistent results. Four studies demonstrated a beneficial effect of statin treatment in at least 1 aspect, 33,34,36,48 while no benefits were reported by the authors of 3 additional studies. 16,17,41 Recently, 2 large-scale multicenter Phase III trials-Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) and High-Dose Simvastatin for Aneurysmal Subarachnoid Hemorrhage (HDS-SAH)-yielded disappointing findings; no benefits of simvastatin treatment were observed in patients with aneurysmal SAH during the STASH study, while authors of the HDS-SAH study reported that treatment with high doses of simvastatin (80 mg) was no more effective than treatment with low doses (40 mg).…”

Pulmonary hypertension in chronic obstructive pulmonary disease

“…As in one earlier study the treatment with simvastatin was able to inhibit the development of elastase‐induced pulmonary emphysema in mice (Takahashi et al, 2008), these findings highlight the diversity in the pleiotropic effects within this class of drugs. Differences between statins are also evident from the clinical trials, which are, nevertheless, showing reduced PH and improvement in lung function in COPD–PH patients treated with statins (Lu et al, 2019; Reed et al, 2011; Zhang et al, 2017). It is worth mentioning that even in those patients that benefited from the statin treatment, reduction in PAP was moderate compared with the complete reversal of PH seen in animal models.…”

The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm

“…It is most severe on the large blood vessels proximally from the ruptured aneurysm. Angiographicaly is proven that the vasospasm is not worsened by surgical manipulation with the vessels [20]. The predictive factors of vasospasm are huge advantage compared to other forms of stroke in terms of therapeutic window for early or preventive treatment.…”