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Should We Put Statins in the Water? A Possible Therapy to Speed Healing of Venous Ulcers

March 20, 2014

Should We Put Statins in the Water? A Possible Therapy to Speed Healing of Venous Ulcers

  1. Jeffrey P. Callen, MD

Results in smaller ulcers were impressive.

  1. Jeffrey P. Callen, MD

Venous insufficiency is a major cause of leg ulcers, and treatment of these ulcers is often difficult. Compression is the primary therapy. Previous reports have suggested benefits from adjuvant treatment with low-dose aspirin (Lancet 1994; 344:164), pentoxifylline (Cochrane Database Syst Rev 2012; 12:CD001733), and most recently, topical beta-blockers (J Am Acad Dermatol 2013; 69:e204). Simvastatin has been shown to have potential benefit for wound healing in animal studies.

These authors performed a double-blind, placebo-controlled trial of simvastatin 40 mg in 66 patients with uninfected ulcers smaller than 10 cm in diameter. Simvastatin was given for 10 weeks with compression; patients were seen every 2 weeks. Results were analyzed for ulcers ≤5 cm and >5 cm. Five patients dropped out. Overall, 72% of simvastatin-treated ulcers healed versus 32% in the control group. Ulcers ≤5 cm had better responses (100% with simvastatin and 46% with control) than larger ulcers. There were no differences in toxicity between the two groups.

Comment

Simvastatin is a relatively nontoxic agent. The results reported in this small but seemingly well-designed study are impressive and warrant consideration of larger studies. Simvastatin may prove to be a promising additional therapy for the management of venous leg ulcers.

  • Disclosures for Jeffrey P. Callen, MD at time of publication Consultant / Advisory board Amgen; Celgene; Xoma Equity Various trust accounts Editorial boards Archives of Dermatology; e-medicine.com; UpToDate Leadership positions in professional societies University of Louisville (Division Chief and Program Director)

Citation(s):

Reader Comments (11)

Futrell DPM Physician, Surgery, Specialized, Woundcare

Keep in mind the underlying etiology. Arterial wounds vs venous wounds. Venous wounds are associated with increased capillary bed pressures...venous congestion. Increased permeability of these capillary beds and therefore induration within dermal/subq tissues. This associated with dermal injury often simply skin stretch beyond dermal elastic ability.

tom del giorno jr M.D. Physician, Family Medicine/General Practice, college level professor

I always understood that when beta blockers were used that left the alpha sites unblocked peripherally and there were vasoconstrictors. I understand that these are venous ulcers but their blood supply is arteriolar/capillary and responsive to the effects of alpha stim.

Futrell DPM Physician, Surgery, Specialized, Woundcare

Remember, venous wounds are directly or indirectly associated with venous congestion. This is addressed by direct pressure, wraps, by collapsing superficial veins and balancing pressures between the deep, superficial systems and maintaining interstitial fluid where it belongs. Or by mechanically collapsing venous beds through sclerosis or ligation. Both either balance deep vs superficial systems or eliminate the connection decreasing capillary bed pressures and reducing induration within dermal tissues allowing healing for a number of reasons.

That being said local/periwound vasoconstriction with the application of a beta blocker can result in an effect to the above.
My understanding is the beta-blockers were applied topically.

DR CHARLES BREEDT

Is the simvastatin used orally or in topical application?

ann cotter

The use of a dietary approach to lower inflammation would have been a useful arm in this study, although it would likely require a longer intervention time. The thnking that we can or should solve such a problem as venous ulcers with one more pharmaceutical without looking at the big picture is why we are in a health care crisis, and exactly where the pharmaceutical compnaies wants our thinking to be.

DEBORAH WAROFF Other, Other, N.A.

Cubans reported considerable success treating ulcerated legs with ozone gas. This may well relate to effect of hyperbaric oxygen but would be much less capital-intensive and could be done in a small space by encapsulating the leg within ozone gas produced by a small machine.

Dr Sachin Kuchya Physician, Family Medicine/General Practice, Jabalpur. India

i do have a diabetic patient who came for a consultation, some 6 months ago. with venous leg ulcers, below knee bilateral. almost all were less than 5 cm in diameter, but for one or two.
with intact venous and arterial circulation, i just initiated statins, cilastazol and low dose aspirin controlled his blood sugars. With local dressings, the ulcers responded well over next 2 months.
with this study, giving corroborating evidence, i feel great.

ROGER FELIX Physician, Family Medicine/General Practice

A lot of researchers have voiced suspicions that statins have an anti-inflammatory effect and a healing effect on endothelial cells that is separate from simply lowering serum cholesterol and LDL levels via inhibition of HMG CoA reductase. This might explain the effect on venous ulcers. And beta blockers don't constrict blood vessels, either. On the contrary, they allow vascular smooth muscle to relax by blocking beta-adrenergic receptors.

Dr. V Kantariya MD Physician, Family Medicine/General Practice

Very interesting! How can statin and beta blocker work in Clinical Dermatology? Oral and topical beta blocker propranolol was introduced as a treatment option for infantile hemangiomas( decreased expression of vascular endothelial growth factor and basic fibroblast factor). Lipophilic statin simvastatin has an evident anti-inflammatory activity.

goverdhan vyas Physician, Internal Medicine, R D Gardi Medical College Ujjain MP India

A novel approach

JUNE M SPOONER Other, Infectious Disease

this is very contradictory. How can statins help a venous ulcer- Unbelievable. to help a venous ulcer one needs meds to help blood flow circulation and if infected also antibiotics.
Also the best treatment esp if ulcer is infected is hyperbaric oxygen treatment. Statins? Also never heard of the use of topical beta blockers of which they CONSTRICT blood vessels.
Could it be possible that pharmaceutical company was involved in this study.

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