Long-term survival rate for heart-transplant patients is significantly higher when statin therapy is begun after surgery, according to an article in the December 10th rapid access issue of Circulation.

Klaus Wenke, M.D., and his German colleagues studied 72 patients who had heart transplants beginning in 1991. All patients were put on a strict low-cholesterol diet after surgery. In addition, 35 patients started daily simvastatin treatment four days after transplant. After four years, the results in the simvastatin plus diet group were “significantly better” than results for the dietary therapy only group, so all patients were offered simvastatin, said Wenke.

After eight years of follow-up, the survival rate for patients who received early simvastatin treatment was 88.6 percent compared with 59.5 percent for patients who did not start simvastatin treatment until four years after transplantation.

The authors looked for possible effects of simvastatin through evaluation of transplant vasculopathy, a major long-term complication of heart transplantation. Early simvastatin treatment cut the incidence as measured by angiography in half, and this effect probably explains the improved survival rate. After eight years, 54.7 percent of patients in the original diet-only group had developed transplant vasculopathy compared with 24.4 percent of patients in the early simvastatin group.

In the study, the average age of patients in the early simvastatin group was 49 years compared with 47 years in the control (dietary therapy only) group. The average donor age was 30 years in the simvastatin group and 34 years in the control arm. In both groups, men outnumbered women: There were 30 men among 35 patients in the early simvastatin group and 34 men among 37 patients in the control group.