Statins in the Prevention and Treatment of Heart Failure: a Review of the Evidence

Figures

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  Fig. 1. The effect of statin therapy on the risk of first non-fatal heart failure hospitalization in 17 trials (a), heart failure death in 14 trials (b), and first composite heart failure outcome in 14 trials (c). All heart failure events within 30 days of myocardial infarction were excluded. Reproduced (as permitted by terms of the CreativeCommonsAttribution License) (http://creativecommons.org/licenses/by/4.0/) from Preiss D, Campbell RT, Murray HM, Ford I, Packard CJ, Sattar N, et al. “The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials.” Eur Heart J. 2015;36:1536–46

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  Fig. 2. In WOSCOPS, after 20 years of follow-up, of the total of 224 subjects hospitalized for, or dying from, HF, 75 (33%) had incident MI preceding HF, whilst 149 (67%) did not. HF events subsequent to MI were reduced by pravastatin treatment, compared with placebo (28 vs 47) (p = 0.022). Incident HF not preceded by MI was also less common in pravastatin-treated patients (68 vs 81), although the difference was not significant (p = 0.22). Abbreviations: F, fatal; HF, heart failure; MI, myocardial infarction; NF, non-fatal; WOSCOPS, West of Scotland Coronary Prevention Study. Footnote: In subjects who experienced HF, the proportion with “antecedent MI” vs “no antecedent MI” does NOT differ between placebo and pravastatin groups (p = 0.24)

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  Fig. 3. Proposed mechanistic pathways on how statins reduce heart failure: (1) by reducing myocardial infarction; (2) by reducing subclinical ischemia (e.g., statins lower troponin levels in WOSCOPS). Abbreviations: LDL, low-density lipoprotein