OBJECTIVE: The development of delayed ischemia caused by cerebral vasospasm 
remains a common cause of morbidity and mortality after aneurysmal subarachnoid 
hemorrhage. Preliminary studies suggest that 3-hydroxy-3-methylglutaryl coenzyme 
A reductase inhibitors (statins) may decrease the risk of vasospasm, but 
additional study is required.
METHODS: Beginning in May 2006, our treatment protocol for patients presenting 
with subarachnoid hemorrhage was altered to routinely include the use of 80 mg 
of simvastatin per day for 14 days. Before this time, only patients with other 
indications for statins were treated. The charts of 203 consecutive patients 
over a period of 27 months were retrospectively reviewed, and 150 patients were 
included in the analysis, of whom 71 patients received statins. These patients 
were compared with 79 untreated patients to determine whether or not the use of 
statins was associated with a reduction in the occurrence of vasospasm, delayed 
infarction, or poor outcome (death, vegetative state, or severe disability).
RESULTS: Patients who were treated with statins and those who were not had 
similar baseline characteristics, although more patients in the former group 
were managed with endovascular coil embolization. There were no statistically 
significant differences in the proportion of patients developing at least 
moderate radiographic vasospasm (41% with statins versus 42% without, P = 0.91), 
symptomatic vasospasm (32% with statins versus 25% without, P = 0.34), delayed 
infarction (23% with statins versus 28% without, P = 0.46), or poor outcome (39% 
with statins versus 35% without, P = 0.61). After adjustment for differences in 
baseline characteristics, including the method of aneurysm treatment, statins 
were still not significantly protective.
CONCLUSION: The addition of statins to standard care was not associated with any 
reduction in the development of vasospasm or improvement in outcomes after 
aneurysmal subarachnoid hemorrhage. If there is a benefit to statin use, it may 
be smaller than suggested by previous studies. However, further randomized 
controlled trials are awaited.