Impacts of Statin Therapy Strategies on Incidence of Ischemic Cerebrovascular Events in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Bayesian Network Meta-Analysis

Background: The exacerbation of neurological outcomes often occurs in aneurysmal subarachnoid hemorrhage (aSAH). Statins have been commonly used for aSAH; however, there is lack of evidence of the pharmacological efficacy of different dosages and types of statins.

Objective: To apply the Bayesian network meta-analysis to analyze the optimal dosage and type of statins for the amelioration of ischemic cerebrovascular events (ICEs) in patients with aSAH.

Methods: We developed the Bayesian network meta-analysis and systemic review to analyze the effects of statins on functional prognosis and the impacts of optimal dosage and type of statins on ICEs in patients with aSAH. The outcome variables of the analysis were the incidence of ICEs and functional prognosis.

Results: A total of 2569 patients with aSAH across 14 studies were included. Analysis of 6 randomized controlled trials showed that statin use significantly improved functional prognosis in patients with aSAH (risk ratio [RR], 0.73; 95% CI, 0.55-0.97). Statins significantly reduced the incidence of ICEs (RR, 0.78; 95% CI, 0.67-0.90). Pravastatin (40 mg/d) decreased the incidence ICEs compared with placebo (RR, 0.14; 95% CI, 0.03-0.65) and was ranked the most effective, presenting with a significantly lower rate of the incidence ICEs than the worst-ranked simvastatin (40 mg/d) (RR, 0.13; 95% CI, 0.02-0.79).

Conclusion: Statins could significantly diminish the incidence of ICEs and enhance functional prognosis in patients with aSAH. Various types and dosages of statins show distinct efficacies.

Comments：

The results of the Bayesian network meta-analysis and systematic review suggest that statins can be effective in improving the functional prognosis and reducing the incidence of ischemic cerebrovascular events (ICEs) in patients with aneurysmal subarachnoid hemorrhage (aSAH). The analysis of 6 randomized controlled trials demonstrated that statin use was associated with a significantly better functional prognosis and a lower incidence of ICEs.

The study also found that pravastatin (40 mg/d) was the most effective statin in reducing the incidence of ICEs, with a significantly lower rate than the worst-ranked simvastatin (40 mg/d). This indicates that the choice of statin and dosage could have an impact on the efficacy of treatment for aSAH.

Overall, the findings suggest that statins could be a valuable pharmacological intervention for patients with aSAH. However, further research is needed to confirm these results and to determine the optimal dosage and type of statin for the treatment of aSAH.

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