The Impact of Statins on Heart Failure | Journal Scan

Study Questions:

Do statins reduce major heart failure (HF) events?

Methods:

The study authors searched for randomized controlled endpoint trials involving statins from 1994 to 2014 in several databases including Cochrane Central Register of Controlled Trials, EMBASE, and Medline. They included primary- and secondary-prevention trials with >1,000 participants who were followed for a time period over 12 months. Outcomes included in evaluation include first nonfatal HF hospitalization, HF mortality, and a composite of first nonfatal HF hospitalization or HF mortality. They excluded HF events occurring <30 days after within-trial myocardial infarction (MI). The authors calculated risk ratios (RRs) with fixed-effects meta-analysis.

Results:

The authors included 132,538 participants from 17 trials who were followed for a period of 4.3 [weighted standard deviation (SD) 1.4] years, statin therapy reduced low-density lipoprotein (LDL) cholesterol by 0.97 mmol/L (or ~37.5 mg/dl). They found that statins reduced first nonfatal HF hospitalizations by 10% (1,344/66,238 vs. 1,498/66,330; RR, 0.90; 95% confidence interval [CI], 0.84-0.97) and the composite HF outcome by 8% (1,234/57,734 vs. 1,344/57,836; RR, 0.92; 95% CI, 0.85-0.99), but not HF mortality (213/57,734 vs. 220/57,836; RR, 0.97; 95% CI, 0.80-1.17). The effect of statins on first nonfatal HF hospitalization was similar whether this was preceded by MI (RR, 0.87; 95% CI, 0.68-1.11) or not (RR, 0.91; 95% CI, 0.84-0.98). Statins reduced risk of nonfatal MI by 26% (2,287 first events in 65,438 participants on statin vs. 3,107 first events in 65,530 on control; RR, 0.74; 95% CI, 0.70-0.78).

Conclusions:

The authors concluded that in primary- and secondary-prevention trials, statins modestly reduced the risks of nonfatal HF hospitalization and a composite of nonfatal HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not.

Perspective:

This large meta-analysis suggests that statin therapy reduced the risk of nonfatal HF hospitalizations and the composite outcome of HF mortality and nonfatal hospitalizations over a 4-year period at best modestly (~10%). As a result, it is unlikely that statins will be utilized in the management of HF due to nonischemic cardiomyopathy.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Acute Heart Failure

Keywords: Cardiomyopathies, Cholesterol, Cholesterol, LDL, Heart Failure, Hospitalization, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipoproteins, LDL, Mortality, Myocardial Infarction, Primary Prevention, Risk, Risk Reduction Behavior, Secondary Prevention


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