Venous Leg Ulcer? – Simvastatin 40 mg/day Speeds Healing

With  leg ulcers less that 5 cm size, all healed in simvastatin group versus 50% control. With ulcers over 5 cm, 67% of simvastatin group closed versus none of control group.

Evangelista, M. T. P., Casintahan, M. F. A., & Villafuerte, L. L. 
Simvastatin as a novel therapeutic agent for venous ulcers: a randomized, double‐blind, placebo‐controlled trial.
British Journal of Dermatology, 170(5), 1151-1157  (2014).
http://onlinelibrary.wiley.com/doi/10.1111/bjd.12883/pdf

  • Venous ulcers up to age 85
  • 32 simvastatin; 34 control group
  • Simvastatin 40 mg/day
  • duration ulcers – over 3.8 years!
  • In simvastatin group, 90%  complete ulcer closure compared 34% in the control group (RR 0.158, 95% CI 0.053–0.474)
  • Healing time 9.17 +/- 1.07 wks
  • Their feeling is that inflammatory processes cause leg ulcers to persist and statins have anti-inflammatory properties. They also thought it helped tissue hypoxia.l_ulcers_infl

Comments – This is a huge benefit to leg venous ulcers. Simvastatin is highly lipophilic (dissolves in fat):

Clin Exp Hypertens. 2008 Oct;30(7):530-40.
Comparison of the effect of lipophilic and hydrophilic statins on serum adiponectin levels in patients with mild hypertension and dyslipidemia: Kinki  Adiponectin Interventional (KAI) Study. Kai T
“simvastatin, which has the highest lipophilicity”

Rosuvastatin (crestor) is not – so potentially it might be better to stick with simvastatin.

Interestingly, simvastatin showed early suggestion that it could help heal MS plaque (being so lipophylic gets into brain easily):
Vollmer, Timothy, et al.
Oral simvastatin treatment in relapsing-remitting multiple sclerosis.
The Lancet 363.9421 (2004): 1607-1608. 
http://www.direct-ms.org/pdf/DrugsMS/Simvastatin%20Vollmer.pdf
They used 80 mg/day and got over 40% reduction in plaque MRI signals over 6 month.

Simvastatin has been found to inhibit certain inflammatory cytokines in MS:
Zhang, Xin, et al.
Simvastatin inhibits secretion of Th17‐polarizing cytokines and antigen presentation by DCs in patients with relapsing remitting multiple sclerosis.
European journal of immunology 43.1 (2013): 281-289.
http://onlinelibrary.wiley.com/doi/10.1002/eji.201242566/full

Atorvastatin also works in the animal model of MS:
Weber, Martin S., et al.
Neither T-helper type 2 nor Foxp3+ regulatory T cells are necessary for therapeutic benefit of atorvastatin in treatment of central nervous system autoimmunity.
Journal of neuroinflammation 11.1 (2014): 29.

However MS patients on Interferon DO NOT benefit from statins in several trials. Recent bottom line was that no conclusion can be made because of “conflicting results”:
Ciurleo, Rosella, Placido Bramanti, and Silvia Marino. “Role of statins in the treatment of multiple sclerosis.” Pharmacological Research (2014).
http://www.sciencedirect.com/science/article/pii/S1043661814000279

Having said that, a fat loving statin is be good for leg ulcers condition -but they also enter and effect the brain easily. Older people might find it causes some cognitive dysfunction while they are on it – and they will have to put up with that…

CNS Drugs. 2014 May;28(5):411-9.
Cognitive effects of statin medications.
Kelley BJ
http://www.ncbi.nlm.nih.gov/pubmed/24504830

 

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