Association Between Use of Statins and Mortality in Patients With Heart Failure and Ejection Fraction of ≥50%

Abstract

Background— The pathophysiology of heart failure with preserved ejection fraction is poorly understood, but may involve a systemic proinflammatory state. Therefore, statins might improve outcomes in patients with heart failure with preserved ejection fraction defined as ≥50%. Methods and Results— Of 46 959 unique patients in the prospective Swedish Heart Failure Registry, 9140 patients had heart failure and ejection fraction ≥50% (age 77±11 years, 54.0% women), and of these, 3427 (37.5%) were treated with statins. Propensity scores for statin treatment were derived from 40 baseline variables. The association between statin use and primary (all-cause mortality) and secondary (separately, cardiovascular mortality, and combined all-cause mortality or cardiovascular hospitalization) end points was assessed with Cox regressions in a population matched 1:1 based on age and propensity score. In the matched population, 1-year survival was 85.1% for statin-treated versus 80.9% for untreated patients (hazard ratio, 0.80; 95% confidence interval, 0.72–0.89; P <0.001). Statins were also associated with reduced cardiovascular death (hazard ratio, 0.86; 95% confidence interval, 0.75–0.98; P =0.026) and composite all-cause mortality or cardiovascular hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.82–0.96; P =0.003). Conclusions— In heart failure with ejection fraction ≥50%, the use of statins was associated with improved outcomes. The mechanisms should be evaluated and the effects tested in a randomized trial.

Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction

“…In an observational study, statin-treated HFpEF patients were also less prone to develop atrial fibrillation 62 . These findings support the positive outcome of small phase 2 trials and HF registries that showed statin use to improve outcome of HFpEF patients 63-65 . It remains to be explored whether other novel approaches to treat systemic inflammation might be effective in HFpEF 66 .…”

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…30 Contemporary evidence from the GWTG-HF registry suggests that ≈47% of individuals admitted to the hospital with HF should have had initiation of ≥1 new medication on discharge. 31 In a large Swedish registry of patients with HF with preserved ejection fraction, statins improved 1-year cardiovascular hospitalization, mortality, and cardiovascular mortality, 32 which could prompt further research with longer follow-up.…”

Significance of Ischemic Heart Disease in Patients With Heart Failure and Preserved, Midrange, and Reduced Ejection Fraction

“…For instance, in HFrEF, revascularization improves long-term outcomes. 32 Moreover, in generalizable settings, statins have been associated with favorable outcome in both HFrEF 33 and HFpEF, 34 although not confirmed in randomized trials. 35 Not only did baseline IHD increase the risk of subsequent IHD events but also that of HF and cardiovascular events and all-cause death.…”