Background: Statins have been shown to have neuroprotective effects, with reduced vasospasm and delayed ischemic neurological deficits (DINDs) following aneurysmal subarachnoid haemorrhage (SAH). However, the role of use of statins for functional outcome and survival after aneurysmal SAH remains controversial.
Objectives: To assess quantitatively the effects of short-term use of statins on DINDs and functional outcome in patients with aneurysmal SAH by using a meta-analysis of the available evidence.
Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to 8 December 2014 to retrieve relevant studies comparing the outcomes between immediate statin treatment in statin-naïve patients and untreated patients following aneurysmal SAH. Fixed-effect or random-effects models, as appropriate, depending on the degree of study heterogeneity, were applied to calculate summary measures.
Results: Thirteen relevant studies, i.e. eight randomized controlled trials (RCTs) and five observational studies, with 2148 participants were finally included in our study. In the RCTs, which enrolled a total of 1150 participants (of whom 555 received statins), statins were found to reduce the occurrence of DINDs significantly (risk ratio (RR) 0.76; 95% confidence interval (CI) 0.61 to 0.94; P = 0.01), but not that of poor functional outcome (RR 1.01; 95% CI 0.87 to 1.16; P = 0.93) or mortality (RR 0.80; 95% CI 0.58 to 1.11; P = 0.18). In the observational studies 504/998 participants received statins. Statin use was not associated with any reduction in DINDs, poor outcome, or mortality. When the results of all studies were combined, statins had statistically significant effect only in reduction of DINDs (RR 0.82; 95% CI 0.71 to 0.94; P = 0.006).
Conclusions: The present meta-analysis suggests that statin use may have potential benefit in the prevention of DINDs in patients with aneurysmal SAH. Based on the current findings, although not assessed in all studies, the role of statins for improving neurological outcome is limited. Further well-designed RCTs with modified protocols in selected patients are still needed.