Cholesterol-Reducing Agents for Treatment of Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis of Randomized Controlled Trials

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.