‘Yes’ or ‘No’ to Routine Statins After Subarachnoid Hemorrhage to Prevent Delayed Cerebral Ischaemia, Vasospasm, and Death?

See related article, pages e47–e52. “ Although there are a few striking examples of treatments for serious disease which really do work extremely well, most claims for big improvements turn out to be evanescent .”Rory Collins and Stephen MacMahon1Do statins reduce the risk of vasospasm, delayed cerebral ischemia, and death after aneurysmal subarachnoid hemorrhage (SAH)? Two recent meta-analyses2,3 reach opposite conclusions. The 2008 meta-analysis by Sillberg et al of the 3 trials available in 2008 concluded: “Initiation of statin therapy after aneurysmal SAH significantly reduces the incidence of vasospasm, delayed ischemic deficits, and mortality. This is consistent with animal research and retrospective studies and supports the routine use of statins in the care of patients with aneurysmal SAH.”2 By contrast, the 2009 meta-analysis by Vergouwen et al concluded: “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.”3 Three questions arise: (1) why have 2 systematic reviews reached different conclusions? (2) Is one of them “right” and the other “wrong”? (3) Should statins be used routinely after aneurysmal SAH?To consider the first question, one must remember that the history of the evaluation of individual therapies is littered with examples in which initial enthusiasm for it (with early adoption by enthusiasts—“this stuff is safe and it’s great”) is followed by a period of disillusion and abandonment (“it doesn’t …