Lynch JR et al. (2005) Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke 36: 2024–2026

Cerebral vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). A recent randomized clinical trial in the US has investigated the ability of simvastatin to reduce vasospasm after aneurysmal SAH.

In this study, 39 patients who had presented to hospital within 48 hours of an SAH were randomized to simvastatin 80 mg daily (n = 19) or placebo (n = 20) for 14 days. Daily blood samples were collected for analysis of serum markers of brain injury such as S100β, and laboratory test results were evaluated weekly for early signs of hepatitis or myositis. The primary endpoint was vasospasm defined by a clinical impression of delayed ischemic neurological deficit not related to rebleed, infection or hydrocephalus, in the presence of one or more confirmatory radiographic tests.

The mean plasma S100β concentration was found to be almost fourfold lower in patients receiving simvastatin than in those receiving placebo (P <0.01), and the mean von Willebrand factor concentration was nearly two fold lower in the treatment arm (P <0.05). Five of the 19 simvastatin patients (26%) showed evidence of vasospasm development, compared with 12 of the 20 patients (60%) receiving placebo. A significant decrease was observed in the maximum mean middle cerebral artery transcranial Doppler velocity for the simvastatin group compared with placebo (P <0.01). No patients developed symptoms of hepatitis or myopathy.

The authors conclude that the use of simvastatin as prophylaxis against delayed cerebral ischemia after aneurysmal SAH is safe and well tolerated, and reduces the incidence of vasospasm.