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Dose-related effect of statins in patients with endovascular coiling or microsurgical clipping for aneurysmal subarachnoid hemorrhage: updated study-level meta-analysis

An Erratum to this article was published on 31 July 2017

This article has been updated

Abstract

Purpose

We aimed to quantitatively assess the effects of short-term statin use on delayed ischemic neurologic deficits (DINDs) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH) through a meta-analysis of the available evidence.

Methods

We searched the electronic databases up to April 8, 2016 to retrieve relevant studies comparing the outcomes between immediate statin-treated in statin-naïve patients and untreated patients following aneurysmal SAH. Meta-analysis was performed using Review Manager 5.3.

Results

Eight randomized controlled clinical trials (RCTs) and 5 observational studies involving 2148 patients met the eligibility criteria. In the RCTs, statins were found to significantly reduce the occurrence of DINDs (relative risk (RR), 0.76; 95% confidence interval (CI), 0.61–0.94; P = 0.01), but did not significantly reduce poor functional outcomes (RR, 1.01; 95% CI, 0.87–1.16; P = 0.93) or mortality (RR, 0.80; 95% CI, 0.58–1.11; P = 0.18). In observational studies, statin use was not associated with any reduction in DINDs, poor outcome, or mortality. Meta-analysis of RCTs indicated a significant reduction in DINDs and mortality in patients with high-dose statin use (RR, 0.63; 95% CI, 0.42–0.95; P = 0.03; I 2 = 0%; and RR, 0.36; 95% CI, 0.15–0.86; P = 0.02; I 2 = 0%, respectively).

Conclusion

The present meta-analysis suggests that statin use may prevent DINDs in patients with aneurysmal SAH. Based on our findings, the role of statins in improving neurological outcome was limited. However, the risk of DINDs and mortality decreased with higher statin doses in a dose-dependent manner. Hence, further well-designed RCTs with modified protocols in specific patients are required.

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Change history

  • 31 July 2017

    An erratum to this article has been published.

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Acknowledgments

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C1234).

Author contributions

All authors contributed to the design of the study. K.-S.C., T.L., W.K., and Y.C. undertook the searches and screened studies for eligibility. K.-S.C., J.M.K., and H.-J.Y. assessed the quality of papers and performed statistical analyses. K.-S.C. and S.H-.L. drafted the manuscript. T.L., W.K., and J.-H.C. moderated disagreements during data collection and analyzed the data. K.-S.C. and S.-H.L. critically revised the manuscript for important intellectual content. All authors revised the manuscript and approved the final version.

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Correspondence to Seon-Heui Lee.

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An erratum to this article is available at https://doi.org/10.1007/s00228-017-2294-3.

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Choi, KS., Kim, J.M., Yi, HJ. et al. Dose-related effect of statins in patients with endovascular coiling or microsurgical clipping for aneurysmal subarachnoid hemorrhage: updated study-level meta-analysis. Eur J Clin Pharmacol 73, 1071–1081 (2017). https://doi.org/10.1007/s00228-017-2221-7

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Keywords

  • Subarachnoid hemorrhage
  • Vasospasm
  • Delayed ischemic neurological deficit
  • Statins
  • Meta-analysis