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Effect of Statin Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage: A Network Meta-Analysis

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An Invited Commentary to this article was published on 29 April 2024

Abstract

Background

There are knowledge gaps regarding the relative efficacy of statins for aneurysmal subarachnoid hemorrhage (aSAH). This study aims to examine the comparative effectiveness and determine the ranking of different statins with network meta‑analysis in patients with aSAH.

Methods

MEDLINE, Embase, Pubmed, and Cochrane Central Register of Controlled Trials were searched from database inception until December 15, 2022. Outcomes included delayed cerebral ischemia (DCI), functional recovery, and mortality. Relative risk (RRs) ratios and associated 95% confidence intervals (CIs) were estimated. The values derived from surface under the cumulative ranking curve were obtained to rank the treatment hierarchy in the analysis.

Results

We identified 13 trials involving 1,885 patients. Atorvastatin 20 mg (RR 0.68, 95% CI 0.53–0.86), pravastatin 40 mg (RR 0.51, 95% CI 0.31–0.77), and simvastatin 80 mg (RR 0.54, 95% CI 0.40–0.70) were superior to the placebo in preventing DCI. Additionally, simvastatin 80 mg (RR 0.60, 95% CI 0.42–0.84) and pravastatin 40 mg (RR 0.56, 95% CI 0.32–0.93) were associated with a decreased risk of DCI than simvastatin 40 mg. Comparisons across treatment durations suggested that short-term (RR 0.62, 95% CI 0.50–0.76) statin therapy reduced risk of DCI.

Conclusions

Simvastatin 80 mg might be the most effective intervention in reducing DCI. Additionally, short-term therapy might provide more benefits. Further research with longer follow-up is warranted to validate the current findings in patients with aSAH who are at high risk of DCI.

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Funding

This research was supported by the National Natural Science Foundation of China (Grant No. 82371318) and Sichuan Provincial Natural Science Foundation (Grant No. 2023NSFSC1564).

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Author notes

  1. Xing Wang and Qi Gan contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Xing Wang, Qi Gan, Chao You & Lu Ma

  2. West China Brain Research Centre, Sichuan University, Chengdu, 610041, Sichuan, People’s Republic of China

    Chao You

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Contributions

XW, LM, and CY designed the meta-analysis, XW and QG searched for relevant studies, XW and QG selected the studies, extracted the relevant information, XW and QG synthesized the data, and XW wrote the first draft of the article. All authors revised the manuscript and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Chao You.

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Wang, X., Gan, Q., You, C. et al. Effect of Statin Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage: A Network Meta-Analysis. Neurocrit Care (2024). https://doi.org/10.1007/s12028-024-01957-9

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