Key result
Atorvastatin improves 6-minute walk distance by ~24m vs rosuvastatin in HFpEF.
Why the study?
Systemic inflammation is a key pathophysiological factor in HFpEF that supports statin use, but whether lipophilic and hydrophilic statins exert different effects on functional capacity, cardiac remodeling, and biomarkers remained to be determined.
Does atorvastatin improve functional capacity and cardiac remodeling compared to rosuvastatin in patients with HFpEF?
RCT (n=59)
Open-label
1:1 automated web-based system
No
Does atorvastatin improve functional capacity and cardiac remodeling compared to rosuvastatin in patients with HFpEF?
Absolute Event Rate: 37% vs 13%
p-value: p=0.020
In patients with HFpEF, statin therapy improved functional capacity and echocardiographic parameters of LV filling pressure, with atorvastatin demonstrating a significantly greater improvement in 6-minute walk distance compared to rosuvastatin.
May favor atorvastatin over rosuvastatin for functional gains in HFpEF; extends head-to-head statin data in preserved EF.
Background Systemic inflammation is an essential pathophysiological factor of heart failure with preserved ejection fraction (HFpEF) that supports the use of statins. The purpose of the study was to determine the effects of statin therapy with atorvastatin or rosuvastatin on functional capacity, cardiac remodeling, profibrotic and inflammatory biomarkers in patients with HFpEF. Since lipophilic and hydrophilic statins may exert different effects on HF, we also compared the effects of lipophilic atorvastatin vs. hydrophilic rosuvastatin. Methods We enrolled 59 patients with HFpEF who had no history of statin use or had not received statins for 6 months. Participants were randomly assigned to receive atorvastatin (20–80 mg a day, n = 30) or rosuvastatin (10–40 mg a day, n = 29) for 6 months. Echocardiography, 6 min walk distance (6MWTD), biomarkers of inflammation (hsCRP and MCP-1), and extracellular matrix homeostasis (PICP and sST2) were analyzed at baseline and after 6 months. Results After 6 months of therapy, atorvastatin was associated with a greater increase in 6MWTD than rosuvastatin, but both statin groups showed comparable improvements in NYHA functional class and bicycle exercise duration. There were comparable decreases in E/e′ ratio and left atrial (LA) volume index, as well as comparable improvements in diastolic (e′ velocity enhancement on exercise) and chronotropic (heart rate enhancement on exercise) reserves in both statin groups. Atorvastatin was superior to rosuvastatin in modifying LA reserve (reservoir strain enhancement on exercise). A significant decrease in blood levels of all biomarkers was observed in the atorvastatin group but not in the rosuvastatin group. Rosuvastatin was associated with a reduction in hsCRP and MCP-1 only in subgroups of patients with baseline values above the median. Conclusions In HFpEF, statin therapy appears to be associated with improved functional capacity, possibly by reducing LV filling pressure and favoring cardiac remodeling. Atorvastatin may provide some additional benefits compared with rosuvastatin. Clinical Trial Registration https://rosrid.ru , identifier AAAA-A18-118022290061-2.
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Ovchinnikov et al. (2026) conducted an RCT in Heart failure with preserved ejection fraction (HFpEF) (n=59). Atorvastatin vs. Rosuvastatin (10-40 mg daily) was evaluated on Change in 6-minute walk test distance (6MWTD) (p=0.020). Atorvastatin improved 6-minute walk distance significantly more than rosuvastatin (mean increase of 37 m vs 13 m, p=0.020) after 6 months in patients with heart failure with preserved ejection fraction.
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