DISSOLUTION OF GALLSTONES WITH SIMVASTATIN, AN HMG COA REDUCTASE INHIBITOR

The aim of this study was to determine whether 12 months of therapy wi th Simvastatin, an HMG CoA reductase inhibitor, would dissolve gallsto nes. Twenty-seven subjects entered the study, all had a fasting oral c holecystogram, ultrasound examination, and fasting serum lipids prior to therapy. In addition, 22 subjects had their gallbladder ejection fr action, after CCK, determined by radionucleotide scanning. Eleven subj ects had the cholesterol saturation index (CSI) of bile calculated bef ore and at the end of 12 months of therapy. Of the 27 subjects, 26 com pleted 12 months of treatment with Simvastatin 20 mg daily. There was a significant fall in the total serum cholesterol (27%, P < 0.0001), L DL cholesterol (31%, P < 0.0001), triglyceride (34%, P < 0.0001) but n o change in HDL after 12 months of therapy. Simvastatin treatment resu lted in a 28% fall in the CSI of bile at the end of therapy (P < 0.01) . The concentrations of individual bile acids did not change with ther apy, and apart from a slight but significant increase in arachidonate, there were no other significant changes in the fatty acid composition of the biliary phospholipids. After 12 months of Simvastatin therapy there was a small decrease in the gallstone diameter but complete diss olution of gallstones was not achieved in any subjects, In conclusion 12 months of therapy with Simvastatin was effective in lowering the se rum lipids and the CSI of bile but was not effective in dissolving gal lstones.