Key result
Statin therapy in patients with HFrEF was associated with a significantly lower risk of major adverse cardiovascular events (adjusted HR 0.53; 95% CI 0.51-0.56; P < 0.0001).
Why the study?
The use of statins in heart failure is controversial, as some large studies showed no benefit in statin-treated heart failure patients despite proven ASCVD risk reduction in patients without heart failure.
Does statin therapy reduce major adverse cardiovascular events in patients with HFrEF?
Cohort (n=15,010)
Does statin therapy reduce major adverse cardiovascular events in patients with HFrEF?
Hazard Ratio: 0.53 (95% CI 0.51–0.56)
p-value: p=< 0.0001
In a real-world cohort of patients with HFrEF, statin therapy was associated with a significantly lower risk of major adverse cardiovascular events, particularly in those with or at high risk for ASCVD.
May support selective statin use in HFrEF with ASCVD; leaves open need for randomized confirmation.
The use of statins in patients with heart failure (HF) is controversial. In patients without HF, statins reduce atherosclerotic cardiovascular disease (ASCVD) risk, including HF-related events. However, in some large studies, no benefit was seen in statin-treated HF patients. The purpose of this study was to determine the impact of statin therapy in HF with reduced ejection fraction (HFrEF). Intermountain Healthcare medical records identified patients with a HF diagnosis and an ejection fraction of ≤40%. Patients prescribed and not prescribed a statin were compared for major adverse cardiovascular events (MACE) (death, myocardial infarction, stroke) (median of 4.5 years follow-up). Statin use was defined as use at or after a HF diagnosis but at least 60 days before MACE or end of follow-up. Cox proportional hazards regression was used to determine the relationship between statin use and outcomes. A total of 15,010 patients (n = 9,641 [64%] on statins) were studied. Statin use was associated with more frequent ASCVD risk factors yet a lower risk of MACE risk (adjusted HR: 0.53; 95% CI: 0.51-0.56; P < 0.0001). Benefit was similar for primary and secondary prevention patients and for prior and new statin prescriptions. Using time-varying hazard ratio analysis, the longer the patient was on a statin, the greater the reduction in risk of MACE (P < 0.0001). These results suggest a potential benefit of selective statin use in the real-world management of HFrEF patients with ASCVD or at high ASCVD risk.
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Anderson et al. (2023) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=15,010). Statin therapy vs. Not prescribed a statin was evaluated on Major adverse cardiovascular events (MACE) (death, myocardial infarction, stroke) (adjusted HR 0.53, 95% CI 0.51-0.56, p=< 0.0001). Statin therapy in patients with HFrEF was associated with a significantly lower risk of major adverse cardiovascular events (adjusted HR 0.53; 95% CI 0.51-0.56; P < 0.0001).
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