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Statins Improve Heart Transplant Survival

Cholesterol-lowering drugs make arteries healthier

MONDAY, Dec. 9, 2002 (HealthDayNews) -- Giving heart transplant recipients a cholesterol-lowering statin drug greatly improves their chances of long-term survival, German cardiologists report.

The eight-year survival rate for transplant patients who were given simvastatin, marketed in the United States as Zocor, was 88.6 percent, or 31 of 35 patients, compared to 59.5 percent, or 22 of 37 patients who got standard medical treatment, says a report by the heart transplant team at the Munich-Bogenhausen hospital.

The research appears in tomorrow's issue of Circulation.

The study was originally planned to run eight years, but the difference in survival, and in the condition of the patients' arteries, was so clear that they all were given simvastatin after four years, the report says.

In particular, the statin treatment prevented a condition called transplant vasculopathy, a thickening of the coronary artery that gradually chokes off blood flow. It also reduced the incidence of transplant rejection episodes that were severe enough to be life-threatening or fatal.

"The transplant arteriopathies [disorders] that a lot of people develop is recognized as a different disease than standard coronary artery disease," says Dr. Daniel J. Rader, director of preventive cardiology at the University of Pennsylvania School of Medicine. "We know that reducing blood cholesterol reduces the risk of heart disease, but we have not had the same reason to believe it reduces the risk of transplant arteriopathy. This is one of the first studies to suggest that it does."

The German study provides convincing evidence for a practice that has become common in most American heart transplant centers, says Dr. Sean Pinney, an attending cardiologist in the Columbia-Presbyterian Medical Center in New York City and a member of the center's heart transplant team.

"All the patients in our center and in other centers are treated with statins," Pinney says. "The interesting thing is that this study started eight years ago, before a consensus emerged on the use of statins. What it does is provide more supportive information about the use of statins in heart transplant patients, reinforcing their role in preventing artery disease."

"The consistent and effective lowering of cholesterol levels played a decisive role," the journal report says.

However, Dr. Edward M. Geltman, professor of medicine at Washington University in St. Louis and director of the heart failure program at Barnes Jewish Hospital there, says the reduction in severe rejection episodes could also be important.

By themselves, statins are not known to have any effect on the immune system. That might change in the presence of cyclosporine A, which is given to transplant patients to prevent the immune system from reacting against the transplanted tissue, Geltman says.

"Our assumption is that the way it works is not entirely by lowering cholesterol but by reducing the number of inflammatory episodes," he says. "It could be due to the way the liver detoxifies cyclosporine, a metabolic pathway in which there is an interaction with the statin. That has been shown for two different statins, simvastatin and pravastatin."

Whatever the reason, the high survival rate in the German study is "outstanding, way beyond the U.S. national average," Geltman says. And statin treatment "is remarkably safe, with no significant side effects," he adds.

What To Do

Get information about heart transplantation from the American Heart Association, which also has a page on statins and other cholesterol-lowering drugs.

SOURCES: Sean Pinney, M.D., attending cardiologist, Columbia Presbyterian Medical Center, New York City; Edward M. Geltman, M.D., professor, medicine, Washington University, St. Louis; Daniel J. Rader, M.D., director, preventive cardiology, University of Pennsylvania School of Medicine, Philadelphia; Dec. 10, 2002, Circulation
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