Statins may improve survival and clinical outcomes in patients with heart failure, particularly those with preserved ejection fraction, although large randomized trials in reduced ejection fraction have not shown mortality benefits.
Do statins improve clinical outcomes in patients with heart failure with reduced or preserved ejection fraction?
This review highlights that while RCT data in HFrEF is neutral, observational evidence suggests statins, particularly lipophilic ones, may improve survival in both HFrEF and HFpEF, warranting further randomized trials.
Statins are one of the standard treatments to prevent cardiovascular events such as coronary artery disease and heart failure (HF). However, data on the use of statins to improve clinical outcomes in patients with established HF remains controversial. We summarized available clinical studies which investigated the effects of statins on clinical outcomes in patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Statins possess many pleiotropic effects in addition to lipid-lowering properties that positively affect the pathophysiology of HF. In HFrEF, data from two large randomized placebo-controlled trials did not show benefits of statins on mortality of patients with HFrEF. However, more recent prospective cohort studies and meta-analyses have shown decreased risk of mortality as well as cardiovascular hospitalization with statins treatment. In HFpEF, most prospective and retrospective cohort studies as well as meta analyses have consistently reported positive effects of statins, including reducing mortality and improving other clinical outcomes. Current evidence also suggests better outcomes with lipophilic statins in patients with HF. In summary, statins might be effective in improving survival and other clinical outcomes in patients with HF, especially for patients with HFpEF. Lipophilic statins might also be more beneficial for HF patients. Based on current evidence, statins did not cause harm and should be continued in HF patients who are already taking the medication. Further randomized controlled trials are needed to clarify the benefits of statins in HF patients.
Techorueangwiwat et al. (Tue,) conducted a review in Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Statins vs. Placebo or no statin therapy was evaluated. Statins may improve survival and clinical outcomes in patients with heart failure, particularly those with preserved ejection fraction, although large randomized trials in reduced ejection fraction have not shown mortality benefits.