title: Three months of simvastatin therapy vs. placebo for severe portal hypertension in cirrhosis: A randomized controlled trial.
abstract: BACKGROUND
  Pleiotropic effects of statins decrease intrahepatic resistance and portal hypertension.
  
  
  OBJECTIVE
  We evaluated the effects of simvastatin on hepatic venous pressure gradient (HVPG) and azygos vein blood flow in cirrhotic patients.
  
  
  METHODS
  A 3-month prospective, randomized, triple-blind trial with simvastatin (40 mg/day) vs. placebo was conducted in patients with cirrhotic portal hypertension. HVPG and azygos blood flow, measured by colour Doppler endoscopic ultrasound, were assessed before and after treatment. The primary endpoint was a decrease in the HVPG of at least 20% from baseline or to ≤12 mmHg after the treatment.
  
  
  RESULTS
  34 patients were prospectively enrolled, and 24 completed the protocol. In the simvastatin group 6/11 patients (55%) presented a clinically relevant decrease in the HVPG; no decrease was observed in the placebo group (p=0.036). Patients with medium/large oesophageal varices and previous variceal bleeding had a higher response rate to simvastatin. HVPG and azygos blood flow values were not correlated. No significant adverse events occurred.
  
  
  CONCLUSIONS
  Simvastatin lowers portal pressure and may even improve liver function. The haemodynamic effect appears to be more evident in patients with severe portal hypertension.
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1); Internal Medicine Department, Fluminense Federal University (UFF), Niterói, RJ, Brazil(2).
authors: Priscila
authors: P
authors: Pollo-Flores
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1).
authors: Mônica
authors: M
authors: Soldan
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1).
authors: Ubiratan Cassano
authors: UC
authors: Santos
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1).
authors: Danielle Gobbi
authors: DG
authors: Kunz
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1).
authors: Denise Espindola
authors: DE
authors: Mattos
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1); Surgery Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil(3).
authors: Alexandre Cerqueira
authors: AC
authors: da Silva
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1).
authors: Roberta Cabral
authors: RC
authors: Marchiori
authors: Internal Medicine Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil(1). Electronic address: g.rezende@superig.com.br.
authors: Guilherme Ferreira da Motta
authors: GF
authors: Rezende
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019821:Simvastatin / Q000627:therapeutic use*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014690:Venous Pressure
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin
keywords: Azygos blood flow; Cirrhotic portal hypertension; HVPG; Simvastatin