A Study of Aspirin and Simvastatin in Pulmonary Arterial Hypertension

Inclusion Criteria:

• Mean pulmonary artery pressure greater than 25 mm Hg at rest with a pulmonary capillary wedge pressure less than 16 mm Hg
• Diagnosis of PAH that is a) idiopathic, b) familial, or c) associated with collagen vascular disease, HIV infection, congenital systemic-to-pulmonary shunt, or former anorexigen use
• Most recent pulmonary function tests showing FEV1/FVC ratio greater than 50% AND one of the following conditions: a) total lung capacity greater than 70% predicted, or b) total lung capacity between 60% and 70% of predicted value with no more than mild patchy interstitial lung disease on high resolution computerized tomography of the chest
• Ability to perform six-minute walk testing without limitations in musculoskeletal function or coordination
• Negative pregnancy test at screening visit for women of childbearing potential
• If female, willing to use adequate form of birth control

Exclusion Criteria:

• PAH related to other etiologies
• Diagnosis of sickle cell disease
• Clinically significant untreated sleep apnea, as diagnosed by polysomnography
• Left-sided valvular disease (more than moderate mitral valve stenosis or insufficiency or aortic stenosis or insufficiency), pulmonary artery or valve stenosis, or ejection fraction less than 45% on echocardiography
• Hospitalized or acutely ill
• Kidney failure
• Initiation of PAH therapy (prostacyclin analogues, endothelin [ET]-1 receptor antagonists, phosphodiesterase [PDE]-5 inhibitors) within 3 months of study entry
• Allergy or hypersensitivity to aspirin or simvastatin
• Absolute indication for aspirin or other anti-platelet therapy
• Current treatment with statin therapy
• Inability or unwillingness to avoid non-steroidal, anti-inflammatory medications for 6 months following study entry
• Current or recent use or planned treatment with one of the following: amiodarone, cyclosporine, itraconazole, ketoconazole, erythromycin, clarithromycin, HIV protease inhibitors, nefazodone, cimetidine, danazol, large quantities of grapefruit juice (more than 1 quart daily), verapamil, fibrates, or niacin
• Peptic or duodenal ulcer diagnosed within 1 year of study entry
• Gastrointestinal bleeding within 6 months prior of study entry
• Bleeding diathesis
• History of intracranial bleeding
• Anemia (hematocrit less than 30%) at screening
• International normalized ratio (INR) greater than 3.0 at screening
• Severe thrombocytopenia (less than 75,000/L) at screening
• Hepatic transaminases greater than twice the upper limit of normal at screening
• Chronic liver disease (e.g., cirrhosis, chronic hepatitis) with portal hypertension
• Current or recent (within 6 months of study entry) chronic heavy alcohol consumption
• History of myositis
• Creatine phosphokinase (CPK) greater than 1.5 times the upper limit of normal at screening
• Abnormalities of the arm or hand or past radical mastectomy that might prevent brachial artery ultrasound
• Pregnant or breastfeeding
• Current use of another investigational drug for PAH
• Received a lung transplant