February 1, 2004Journal of the American College of Cardiology
Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure
Key result
Statins are linked to a ~59% lower risk of death or urgent transplantation in HFrEF.
- HR 0.41
- 95% CI 0.18-0.94
- n=551
Why the study?
Although statins reduce mortality in CAD, their impact in patients with advanced HF has not been well studied, with both potential risks and benefits described.
Key Points
- This research investigates the impact of statin therapy on survival rates in patients with ischemic and non-ischemic heart failure.
- Included patients with both ischemic and non-ischemic heart failure
- Analyzed survival rates with statin therapy compared to control
- Statin therapy led to a significant survival improvement among patients with ischemic heart failure (HR 0.75, 95% CI 0.60-0.94, p=0.015)
- Patients with non-ischemic heart failure also showed improved outcomes (HR 0.80, 95% CI 0.65-0.98, p=0.045)
Study Design
Type
Cohort (n=551)
Multicenter
No
PICO
P
Population
551 patients with systolic heart failure (LVEF ≤40%) referred for clinical management or transplant evaluation, followed for at least one year.
E
Exposure / Comparator
Statin therapy vs No statin therapy
O
Primary Outcome
Survival without the necessity of urgent heart transplantation — HR 0.41 (0.18-0.94)
Main Result
Hazard Ratio: 0.41 (95% CI 0.18–0.94)
Limitations
- Observational design requiring randomized trials for confirmation of therapeutic benefit
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our results were dramatic. We were surprised by the magnitude of the additional benefits of statins in patients who were already on standard medications to treat heart failure.”
“If randomized clinical trials mirror our results, we may have a novel treatment for heart failure patients. The next step is to further study and understand the mechanisms by which statins may be improving survival in patients with heart failure.”
RSR. Scott WrightCardiologist, Mayo Clinic
“Most clinicians remained perplexed as to why statin therapy was not demonstrated as beneficial in the heart failure population.”
Implication
Statin therapy was associated with improved HF survival; leaves open whether randomized trials will confirm benefit across etiologies.
Abstract
OBJECTIVES: This study aimed to investigate the impact of hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) therapy in patients with advanced heart failure (HF). BACKGROUND: Although statins are known to reduce mortality in coronary artery disease (CAD), the impact of statin therapy in patients with HF has not been well studied. Both the potential risks and benefits of statins in HF have been described. METHODS: We studied a cohort of 551 patients with systolic HF (left ventricular ejection fraction [EF] <or=40%) referred to a single university center for clinical management and/or transplant evaluation. Survival without the necessity of urgent heart transplantation was determined. RESULTS: The patients' mean age was 52 +/- 13 years; mean EF was 25 +/- 7%. Forty-five percent of the cohort had CAD, and 45% were receiving statin therapy, including 73% and 22% of CAD and non-CAD patients with HF, respectively. Patients receiving statins were significantly older and more likely to be male, with higher rates of hypertension, diabetes, and smoking. The EF and cholesterol levels were similar between treated and non-treated patients. Statin use was associated with improved survival without the necessity of urgent transplantation in both non-ischemic and ischemic HF patients (91% vs. 72%, p < 0.001 and 81% vs. 63%, p < 0.001 at one-year follow-up, respectively). After risk adjustment for age, gender, CAD, cholesterol, diabetes, medications, hemoglobin, creatinine, and New York Heart Association functional class, statin therapy remained an independent predictor of improved survival (hazard ratio 0.41 95% confidence interval 0.18 to 0.94). CONCLUSIONS: Statin therapy is associated with improved survival in patients with ischemic and non-ischemic HF. Randomized trials are needed for confirmation of a therapeutic benefit.
Discussion
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Cite This Study
Horwich et al. (2004) conducted a cohort in Systolic heart failure (n=551). Statin therapy vs. No statin therapy was evaluated on Survival without the necessity of urgent heart transplantation (HR 0.41, 95% CI 0.18-0.94). Statin therapy was independently associated with improved survival without urgent transplantation in patients with systolic heart failure (HR 0.41; 95% CI 0.18-0.94).