Clinical evidence of efficacy of simvastatin for aneurysmal subarachnoid hemorrhage

Objective The present study was performed to explore the therapeutic potential of simvastatin in subarachnoid hemorrhage (SAH) in the context of the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) trial. Methods MEDLINE, EMBASE, and the Cochrane Library were searched for all randomized controlled trials (RCTs) investigating the therapeutic effect of simvastatin on aneurysmal SAH. We applied a random-effects model to calculate the data. Results Five RCTs involving 951 patients met the eligibility criteria. We found no statistically significant effects on vasospasm detected by transcranial cerebral Doppler (relative risk [RR], 0.91; 95% confidence interval [CI], 0.55-1.49), delayed cerebral ischemia (DCI) (RR, 0.85; 95% CI, 0.63-1.14), or all-cause mortality (RR, 1.02; 95% CI, 0.67-1.54). Subgroup analysis showed that these consolidated results were stable at different doses, different times to start of treatment, and different courses of treatment in all included RCTs. Sensitivity analysis showed that the STASH trial, which had a large population, did not influence the consolidated results of all three outcomes. Conclusions Simvastatin showed no benefits in decreasing the incidence of vasospasm, DCI, or all-cause mortality after aneurysmal SAH. We conclude that patients with SAH should not be treated routinely with simvastatin during the acute stage.