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Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial.

Abstract：

BACKGROUND & AIMS: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. This randomized controlled trial evaluated the effects of continuous simvastatin administration on the hepatic venous pressure gradient (HVPG) and its safety in patients with cirrhosis and portal hypertension. METHODS:Fifty-nine patients with cirrhosis and portal hypertension (HVPG > or =12 mm Hg) were randomized to groups that were given simvastatin 20 mg/day for 1 month (increased to 40 mg/day at day 15) or placebo in a double-blind clinical trial. Randomization was stratified according to whether the patient was being treated with beta-adrenergic blockers. We studied splanchnic and systemic hemodynamics and variables of liver function and safety before and after 1 month of treatment. RESULTS:Simvastatin significantly decreased HVPG (-8.3%) without deleterious effects in systemic hemodynamics. HVPG decreases were observed in patients who were receiving beta-adrenergic blockers (-11.0%; P = .033) and in those who were not (-5.9%; P = .013). Simvastatin improved hepatic, fractional, and intrinsic clearance of indocyanine green, showing an improvement in effective liver perfusion and function. No significant changes in HVPG and liver function were observed in patients receiving placebo. The number of patients with adverse events did not differ significantly between groups. No patient was withdrawn from the study based on adverse events. CONCLUSIONS:Simvastatin decreased HVPG and improved liver perfusion in patients with cirrhosis. These effects were additive with those of beta-adrenergic blockers. The beneficial effects of simvastatin should be confirmed in long-term clinical trials for portal hypertension.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Abraldes JG,Albillos A,Bañares R,Turnes J,González R,García-Pagán JC,Bosch J

doi

10.1053/j.gastro.2009.01.043

subject

Has Abstract

pub_date

2009-05-01 00:00:00

pages

1651-8

issue

5

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(09)00144-9

journal_volume

136

pub_type

杂志文章,多中心研究,随机对照试验

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