After eight years, the survival rate for patients who received early simvastatin treatment was 88.6 percent compared to 59.5 percent of patients who didn't start simvastatin treatment until four years after transplant, says Klaus Wenke, M.D., lead author of the paper and assistant professor in the division of cardiac surgery at Munich-Bogenhausen, Munich, Germany.
The authors also studied the effects of simvastatin on the development of coronary artery thickening called transplant vasculopathy, which is a major long term complication of heart transplantation. Early simvastatin treatment cut in half the incidence of vessel thickening as measured by angiography, which probably explained the improved survival rate. After eight years, 54.7 percent of the patients in the untreated group had developed transplant vasculopathy, compared to just 24.4 percent of patients in the simvastatin group.
Wenke and colleagues studied 72 patients who had heart transplants beginning in 1991. All patients were put on a strict low-cholesterol diet after surgery. Thirty-five patients started daily simvastatin treatment four days after transplant, while 37 remained on dietary therapy alone. After four years, the results in the simvastatin group were "significantly better" so all patients were offered simvastatin, says Wenke.
Benefits of simvastatin may be due not only to its ability to reduce cholesterol, but also to its ability to reduce the growth of smooth muscle cells (cells in the vessel wall that contribute to vessel thickening).
In the study, the average age of patients in the simvastatin group was 49 and 47 in the control group. The average donor age was 30 in the simvastatin group and 34 in the control arm. In both groups, men outnumbered women: 30 men in the simvastatin group and 34 men in control group.
Co-authors are Bruno Meiser, M.D.; Joachim Thiery, M.D.; Dorothea Nagel, Ph.D.; Wolfgang von Scheidt, M.D.; Karl Krobot, M.D., M.P.H.; Gerhard Steinbeck, M.D.; Dietrich Seidel, M.D.; and Bruno Reichart, M.D.
NR02 – 1217 (Circ/Wenke)
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