Treatment of pediatric pulmonary hypertension with simvastatin: an observational study.
BACKGROUND
Animal studies and an adult human case series suggest that statins may have a role in the treatment of pulmonary hypertension. We reviewed the results of empirical therapy for children at Primary Children's Medical Center to determine whether simvastatin had a favorable effect on non-invasive estimates of pulmonary arterial pressure.


METHODS
The medical records of children with pulmonary hypertension who were treated with simvastatin were reviewed. Mean measurements of the gradient of tricuspid valve regurgitation before and after treatment were compared by a paired t-test. A favorable response to simvastatin was defined as a 20% decrease in the average measurement of the gradient of tricuspid valve regurgitation or a 20% decrease in right ventricular anterior wall thickness when tricuspid valve regurgitation resolved during treatment. Potential factors associated with a favorable response to simvastatin were identified with a Fisher exact test.


RESULTS
Twelve children, 4-15 years of age, had adequate Doppler velocity waveforms to reliably measure gradients of tricuspid valve regurgitation during a period of 1 year before treatment. Eleven patients had gradients of tricuspid valve regurgitation that could be measured during a period of 1 year after treatment. Patients were treated with simvastatin 0.09-0.28 mg/kg/day. Collectively, there was no difference between the average measurements of the gradient of tricuspid valve regurgitation before and after treatment (66 ± 21 mmHg vs. 63 ± 28 mmHg). Three of the five patients with clinical findings consistent with alveolar hypoxia and none of the seven patients without clinical findings consistent with alveolar hypoxia had a favorable response to treatment with simvastatin (P = 0.05).


CONCLUSIONS
Simvastatin may decrease pulmonary arterial pressure in a subset of patients with pulmonary hypertension.
Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah. wilsontking@gmail.com, wilson.king@hsc.utah.edu.
Wilson T
WT
King
Ronald W
RW
Day
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D012189:Retrospective Studies; D019821:Simvastatin / Q000627:therapeutic use*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin