Pleiotropic effects of simvastatin in patients with peripheral arterial occlusive disease

Abstract

Background. Simvastatin has a consolidated position in the primary and secondary prevention of cardiovascular disease in high risk patients. Simvastatin, independently of its hypolipaemic action, changes endothelial function, stabilises atheromatous plaques and exerts antithrombotic and anti-inflammatory action. The purpose of this paper was to verify the pleiotropic action of simvastatin in PAOD patients with normo- and hypercholesterolaemia.
Material and methods. Twenty patients with peripheral aterial occlusive disease (PAOD): 10 normocholesterolaemic (NCH) and 10 hypercholesterolaemic (HCH), 41-75 years, old were included in the study. The patients were treated with 40 mg of simvastatin daily for 3 months. At the beginning of the therapy, after one month and three months of treatment lipid levels and clinical investigations were performed. Laboratory estimations were determined before starting therapy and 3 hours after ingestion of simvastatin tablets. The same procedure was repeated after one month and three months of therapy, always 12 hours after the last dose and 3 hours after intake of the tablet.
Results. Simvastatin caused significant reduction of TC, LDL and TG levels in both study groups. No changes in HDL levels were observed. An increase of ABI and FMD in the NCH group were observed. A significant increase of FMD, of pain-free and total walking distances were seen In HCH patients; no changes in ABI were observed. In both study groups significant fibrinolytic and antiplatelet action were observed, more distinct in the HCH group. No changes in the levels of t-PA antigen, RBC deformability and aggregability were seen in both study groups.
Conclusions. Simvastatin therapy caused clinical improvement in PAOD patients independently of its lipid lowering properties. These beneficial simvastatin effects may be related to the pleiotropic action and restoration of endothelial function.