Simvastatin is effective in lowering portal pressure and improving liver perfusion in patients with cirrhosis, according to findings published in the May issue of Gastroenterology

Simvastatin

“Simvastatin improves liver generation of nitric oxide and hepatic endothelial dysfunction in patients with cirrhosis, so it could be an effective therapy for portal hypertension,” Dr. Jaime Bosch, of the University of Barcelona, Spain, and colleagues point out.

In a double-blind, controlled trial, the researchers randomized 59 patients to simvastatin (20 mg/day for 1 month, increased to 40 mg/day at day 15) or placebo for 30 days. Portal hypertension was defined as hepatic venous pressure gradient of 12 mm Hg or greater.

Randomization was stratified according to whether patients were being treated with beta-adrenergic blockers. The final analysis included 27 placebo-treated patients and 28 simvastatin-treated patients.

Treatment with simvastatin resulted in a reduction of the hepatic venous pressure gradient that was significantly greater than treatment with placebo (-8.3% vs. -1.6%, respectively). Simvastatin further reduced hepatic venous pressure gradient in patients receiving beta-adrenergic blockers (-11.0%; p = 0.033) compared with those who were not (-5.9%; p = 0.013).

“In patients treated with placebo, no significant changes in indocyanine green clearance, fractional clearance, and intrinsic clearance were observed,” Dr. Bosch and colleagues note. “In contrast, simvastatin administration markedly increased indocyanine green clearance, fractional clearance, and intrinsic clearance, suggesting that simvastatin increased effective liver perfusion and improved liver function.”

Adverse events were observed in seven patients in the placebo group and three in the simvastatin group. None of the participants withdrew from the study because of adverse events.

Simvastatin has “clear potential” for the treatment of portal hypertension in cirrhosis patients, the researchers conclude, and recommend that these effects be confirmed in larger clinical trials.