Should Heart Failure Patients Start Taking Statins?

Summary and Comment |
October 31, 2006

Should Heart Failure Patients Start Taking Statins?

  1. JoAnne M. Foody, MD

Patients with chronic HF who initiated statin therapy had reduced risks for death and hospitalization, according to an observational study.

  1. JoAnne M. Foody, MD

Statins benefit a broad range of patients with, or at risk for, coronary artery disease (CAD). A recent observational study of elderly patients hospitalized with heart failure (HF) also showed an association between statin prescription at discharge and reduced 1- and 3-year risks for death (Journal Watch Cardiology Mar 30 2006). Now, researchers have studied statin use in outpatients and inpatients with HF.

In an industry-funded study, researchers analyzed data from 24,598 patients (mean age, 71) in both ambulatory and hospital settings who were enrolled in a northern California health plan, were diagnosed with HF from 1996 through 2004, and were eligible for lipid-lowering therapy but were not taking it upon enrollment in the health plan. Pharmacy records showed that 51% of the cohort initiated statin therapy during the 120 days before HF diagnosis. These incident statin users were younger, more often male, and more likely to have histories of MI, CAD, revascularization, diabetes, and hypertension than were nonusers. Median follow-up was 2.4 years.

In analyses adjusted for potential confounders, including cholesterol level and use of other cardiovascular drugs, mortality risk was significantly lower among incident statin users than among nonusers (14.5 vs. 25.3 deaths per 100 patient-years; hazard ratio, 0.76), as was the risk for HF hospitalization (HR, 0.79). The findings were consistent by HF etiology, CAD status, and the likelihood of receiving statin therapy given other demographic and clinical characteristics.

Comment

These observational data reinforce previous findings in suggesting a potential survival benefit of statins in HF patients, and they broaden the suggestion to both inpatient and outpatient settings. A recent randomized trial in about 100 patients with nonischemic HF documented improvements in left-ventricular size and function with statin use (Journal Watch Cardiology Feb 23 2006), but we need larger trials to assess outcomes. For now, HF itself is not an indication for statin use.

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