OBJECT: Vasospasm is the major cause of disability and death after aneurysmal 
subarachnoid hemorrhage (aSAH). Although the results of 2 randomized clinical 
trials demonstrated that statin decreases the incidence of symptomatic cerebral 
vasospasm after aSAH, retrospective studies have failed to confirm this. The 
authors conducted a prospective observational study to determine whether a 
standardized regimen of simvastatin would reduce the incidence of cerebral 
vasospasm and improve neurological outcomes in patients with aSAH.
METHODS: Since 1991, all patients with aSAH admitted to the authors' institution 
have been prospectively followed up with standardized outcomes recording. 
Starting in September 2005, all patients admitted with aSAH were given enteral 
simvastatin (80 mg/day for 14 days) in addition to the standard care. The 
incidence of symptomatic cerebral vasospasm, length of hospitalization, 
in-hospital mortality rate, and discharge Glasgow Outcome Scale scores in these 
170 patients were compared to data obtained in 170 consecutive patients who 
underwent treatment in our unit prior to the introduction of statin therapy.
RESULTS: The 5-year study period included 340 consecutively treated patients 
(170 who received statins and 170 who did not). Patients who received 
simvastatin therapy were more frequently male (29 vs 20%) and had a smaller 
median aneurysm diameter (6 vs 7 mm). Baseline characteristics were otherwise 
similar between the cohorts. There were no differences in the incidence of 
symptomatic vasospasm (25.3 vs 30.5%; p = 0.277), in-hospital mortality rate (18 
vs 15%; p = 0.468), length of hospitalization (21 +/- 15 vs 19 +/- 12 days; p = 
0.281), or poor outcome at discharge (Glasgow Outcome Scale Scores 1-2: 21.7 vs 
18.2%; p = 0.416) between the simvastatin and nonstatin cohorts. There were no 
statin-related complications.
CONCLUSIONS: The uniform introduction of simvastatin did not reduce the 
incidence of symptomatic cerebral vasospasm, death, or poor outcome in patients 
with aSAH. Simvastatin was well tolerated, but its benefit may be less than has 
been previously reported.