MedWire News: The efficacy of statins in patients with aneurysmal subarachnoid hemorrhage (SAH) has been called into question by the results of a systematic review and meta-analysis, which found no beneficial effect of statin therapy for this indication.
The new study casts doubt on current practice in many hospitals, whereby patients with aneurysmal SAH are routinely treated with statins. The results also conflict with those of a separate meta-analysis by Sillberg et al, which found that statins reduced vasospasm, delayed cerebral ischemia, and decreased mortality in patients with aneurysmal SAH.
The latest research was undertaken by Mervyn Vergouwen (Toronto Western Hospital, Ontario, Canada) and team with the aim of clarifying the effect of statin therapy in aneurysmal SAH.
They included in their meta-analysis four randomized controlled trials, involving 190 patients with aneurysmal SAH, treated with either statins (pravastatin or simvastatin) or placebo. Three of the studies had been included in the Sillberg et al meta-analysis while the fourth was newly published.
Analysis using random-effects models revealed no statistically significant effect of statin therapy on transcranial Doppler vasospasm (pooled risk ratio[RR]=0.99), delayed cerebral ischemia (RR=0.57), poor outcome (RR=0.92), or mortality (RR=0.37), Vergouwen and co-authors report in the journal Stroke.
A subgroup analysis using pooled homogenous data from the three simvastatin studies also found no significant effect on any of the outcome parameters. In the fourth study, patients randomly assigned to take pravastatin had a significantly lower risk for delayed cerebral ischemia (RR=0.17), but not for other outcomes.
Vergouwen and colleagues say that their meta-analysis used a “more stringent approach” than the earlier study and is thus methodologically more robust. Nevertheless they urge caution in interpreting their findings and admit that a benefit of statins “cannot be excluded.”
“The results of the present systematic review do not lend statistically significant support to the finding of a beneficial effect of statins in patients with aneurysmal SAH as reported in a previous meta-analysis,” they conclude.
“Only the results of a large-scale Phase III study such as the Statins for Aneurysmal Subarachnoid Hemorrhage (STASH) trial will give the definitive answer whether statin treatment is beneficial in patients with aneurysmal SAH.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
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