Recently, two randomized controlled phase II studies showed that acute 
initiation of statin treatment directly after aneurysmal subarachnoid hemorrhage 
(SAH) decreases the incidence of radiologic vasospasm and clinical signs of 
delayed cerebral ischemia (DCI), and even reduces mortality. It was hypothesized 
that the beneficial effect resulted from pleiotropic effects of statins. The 
purpose of this study was to investigate the biologic effects of acute statin 
treatment in patients with SAH. We performed an exploratory single-center, 
prospective, randomized, double-blind, placebo-controlled trial. Patients were 
randomized to simvastatin 80 mg or placebo once daily. A total of 32 patients 
were included. There were no statistically significant differences in clinical 
baseline characteristics. With regard to primary outcomes, there were 
significant differences by treatment group for total cholesterol and low-density 
lipoprotein (LDL) cholesterol (P<0.0001), but not for parameters of coagulation, 
fibrinolysis, endothelium function, and inflammation. With regard to secondary 
outcomes, no differences were observed in the incidence of transcranial Doppler 
vasospasm, clinical signs of DCI, and poor outcome. We conclude that both the 
primary and secondary outcome results of this study do not support a beneficial 
effect of simvastatin in patients with SAH.