High-Dose Simvastatin Is Effective in Preventing Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study in Korean Patients

Abstract

ObjectiveThe goal of this study was to assess the effect of high-dose simvastatin on cerebral vasospasm and its clinical outcome after aneurysmal subarachnoid hemorrhage (SAH) in Korean patients.MethodsThis study was designed as a prospective observational cohort study. Its subjects were aneurysmal SAH patients who had undergone aneurysm clipping or coiling. They were assigned to 1 of 3 groups : the 20 mg, 40 mg, and 80 mg simvastatin groups. The primary end-point was the occurrence of symptomatic vasospasm. The clinical outcome was assessed with the modified Rankin Scale (mRS) score after 1 month and 3 months. The risk factors of the development of vasospasm were assessed by logistic regression analysis.ResultsNinety nine patients with aneurysmal SAH were treated and screened. They were sequentially assigned to the 20 mg (n=22), 40 mg (n=34), and 80 mg (n=31) simvastatin groups. Symptomatic vasospasm occurred in 36.4% of the 20 mg group, 8.8% of the 40 mg group, and 3.2% of the 80 mg group (p=0.003). The multiple logistic regression analysis showed that poor Hunt-Hess grades (OR=5.4 and 95% CI=1.09-26.62) and high-dose (80 mg) simvastatin (OR=0.09 and 95% CI=0.1-0.85) were independent factors of symptomatic vasospasm. The clinical outcomes did not show a significant difference among the three groups.ConclusionThis study demonstrated that 80 mg simvastatin treatment was effective in preventing cerebral vasospasm after aneurysmal SAH, but did not improve the clinical outcome in Korean patients.

Serum mannose-binding lectin levels after aneurysmal subarachnoid hemorrhage

“…In agreement with previous data in ischemic stroke (15,17,18), MBL has the potential to be a good prognostic predictive biomarker in aSAH. In addition, the mean age of aSAH patients in this study was about 15 years younger than that of most cases (35). Nevertheless, in eastern part of China, the mean age of aSAH patients reported in some articles (36)(37)(38) was similar to that in our study.…”

Dose-Dependent Effects of Statins for Patients with Aneurysmal Subarachnoid Hemorrhage: Meta-Regression Analysis

“…The literature search strategy yielded a total of 18 studies for analysis, which comprised of randomized controlled trials (RCTs) [16,17,19,20,[36][37][38][39][40][41][42][43], prospective observational cohort studies [15,44] and retrospective observational studies [18,[45][46][47]. This represented 2594 patients.…”

“…Nine studies (50.0%) were randomized control trials, with blinding of participants and personnel [16,17,19,20,36,38,40,41,43]. Risk of overall bias was considered high in 7 studies (39.0%) [15,37,39,42,[44][45][46], whereas the risk was minimal in 8 studies (44.4%) [16,17,19,20,36,38,40,41].…”

“…Only 40 mg of pravastatin daily and 4 mg of pitavastatin daily were investigated. Two studies did not include a control/placebo group [17,44], one of which included three statin treatment groups [44]. One study involved a simvastatin and magnesium treatment arm [46], but this arm was excluded from analysis.…”

“…While relative risk measures may be more consistent [55,56], they are relative and require measurement of absolute risk at some baseline, typically placebo or the nodose scenario. In contrast, absolute risk is directly related to incidence and importantly, absolute risk measures enabled inclusion of studies that were not placebo controlled [17,44]. Utilization of absolute risk and absolute risk reduction also allowed derivation of indices such as number needed to treat (Table 6).…”