Statin therapy modifies the prognostic value of immune-inflammatory indices in acute HFpEF: Data from the LECRA-HF registry

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) pathophysiology is associated with inflammation, however this knowledge is yet to be utilized in clinical practice. AIMS: We conducted a retrospective study to evaluate the association between statin therapy, levels of immune-inflammatory biomarkers (IIBs), and 5-year all-cause mortality among HFpEF in Polish population. METHODS: We analyzed 311 HFpEF patients hospitalized in years 2009-2019 included in the LECRA-HF Registry. IIBs (neutrophil-to-lymphocyte ratio [NLR], derived NLR [dNLR], lymphocyte-to-monocyte ratio [LMR], systemic immune-inflammation index [SII], and pan-immune-inflammation value [PIV]) were calculated and patients were stratified according to statin therapy at discharge. All-cause mortality has been analyzed with median follow-up time of 52 months. RESULTS: 203 patients (65%, median age 77 years, 59.6% females) were receiving statin therapy, while 108 patients (35%, median age 75 years, 56.5% females) were not prescribed statins. Elevated SII without statins was associated with the lowest survival, whereas high LMR and low PIV among statin users conferred the best outcomes. LMR was associated with reduced mortality in HFpEF patients not receiving statins (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.26-0.82). NLR (OR, 1.51; 95% CI, 1.03-2.22; P = 0.034), dNLR (OR, 1.92; 95% CI, 1.07-3.45; P = 0.029), SII (OR, 2.09; 95% CI, 1.19-3.67; P = 0.010) and PIV (OR, 2.32; 95% CI, 1.13-4.78; P = 0.023) independently predicted mortality in the non-statin group, with interaction between statin therapy and dNLR (P for interaction = 0.042) and PIV (P for interaction = 0.036). CONCLUSIONS: The IIBs, particularly dNLR and PIV, were independent predictors of mortality in statin-naive HFpEF patients, whereas their prognostic associations differed according to statin prescription status.