Long-term Clinical Outcomes of Statin Use for Chronic Heart Failure: A Meta-analysis of 15 Prospective Studies

Wang, Jianqiang; Wu, Guorong; Wang, Zheng; Xiao-ping, Dai; Li, Xiangrong

doi:10.1016/j.hlc.2013.07.012

Cited by 36 publications

(30 citation statements)

References 39 publications

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“…Atorvastatin treatment appeared to reduce all-cause mortality (RR ¼ 0.61, P ¼ .05) and rehospitalization for HF (RR ¼ 0.44, P ¼ .04) compared with nonatorvastatin therapy. 4 These effects were also seen in the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study 5 and the large Treating to New Targets (TNT) study. 6 According to TNT, improvement in kidney function may be related to the beneficial effect of high-dose atorvastatin on HF hospitalizations.…”

mentioning

confidence: 88%

“…3 A few days ago, a meta-analysis of 15 prospective studies, involving 45 110 patients, addressed the issue of statin treatment for HF. 4 The study included patients with both preserved and reduced ejection fraction. Additional statin treatment was associated with reduced all-cause mortality (risk ratios [RRs] ¼ 0.71, 95% confidence intervals [CIs] 0.61-0.83) and reduced rehospitalization rate for HF (RR ¼ 0.84, 95% CI 0.74-0.96).…”

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confidence: 99%

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Treating Heart Failure With Preserved Ejection Fraction

2013

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Not long ago we wrote a review on the treatment of heart failure (HF) with preserved ejection fraction (HFpEF). 1 We concluded that careful use of diuretics and statins was the only possible readily available modalities useful in treating HfpEF 1 ; there is no universally accepted treatment for this condition. 2 Until some months ago, there was a hope that spironolactone would improve the prognosis of HFpEF. However, the recently published results of the Aldosterone Receptor Blockade in Diastolic HF (Aldo-DHF) trial, which included 422 patients with chronic HF, left ventricular (LV) ejection fraction of 50%, and echocardiographic evidence of LV diastolic dysfunction, showed that long-term aldosterone receptor blockade improved LV diastolic function but had no effect on maximal exercise capacity, HF symptoms, or quality of life in HFpEF. 3 A few days ago, a meta-analysis of 15 prospective studies, involving 45 110 patients, addressed the issue of statin treatment for HF. 4 The study included patients with both preserved and reduced ejection fraction. Additional statin treatment was associated with reduced all-cause mortality (risk ratios [RRs] ¼ 0.71, 95% confidence intervals [CIs] 0.61-0.83) and reduced rehospitalization rate for HF (RR ¼ 0.84, 95% CI 0.74-0.96). 4 Statin treatment, however, had little impact on pump failure mortality, cardiovascular mortality, and sudden cardiac death. Atorvastatin treatment appeared to reduce all-cause mortality (RR ¼ 0.61, P ¼ .05) and rehospitalization for HF (RR ¼ 0.44, P ¼ .04) compared with nonatorvastatin therapy. 4 These effects were also seen in the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study 5 and the large Treating to New Targets (TNT) study. 6 According to TNT, improvement in kidney function may be related to the beneficial effect of high-dose atorvastatin on HF hospitalizations. 7 This was also confirmed by GREACE, 8 which a few years before TNT had shown that there is a clinically significant improvement in renal function that is independent of the hypolipidemic action of atorvastatin. 9 The renal function protection, even improvement, with statins has been recently reported by a meta-analysis. 10 If statins are underused in HF, there should probably be an effort to generalize their use in these patients.

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confidence: 88%

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confidence: 99%

Treating Heart Failure With Preserved Ejection Fraction

2013

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“…Atorvastatin significantly reduced the rates of adverse outcomes including SCD in the highest quartile of LDL-C (≥145 mg/dl [>3.76 mmol/L]) in patients with DMt2 undergoing hemodialysis [28,29] . The most recent meta-analysis of 15 studies and 45 110 patients indicated that statins decreased all-cause mortality in CHF patients, but there was no statistically significant effect of statin therapy on reduction in the risk of sudden cardiac death in these patients [30] . Studies included in this meta-analysis evaluated simvastatin (n = 1), rosuvastatin (n = 2), atorvastatin (n = 3), multiple statins (n = 4) and non-specified statin treatment (n = 5).…”

Section: Statin Therapy and Scdmentioning

confidence: 99%

“…Studies included in this meta-analysis evaluated simvastatin (n = 1), rosuvastatin (n = 2), atorvastatin (n = 3), multiple statins (n = 4) and non-specified statin treatment (n = 5). Based on the subanalysis the authors suggested that some statins, such as atorvastatin (hydrophilic), might provide more beneficial effects in CHF patients [30] . The kind of statin chosen for the therapy might be an important factor influencing the efficacy in patients with CHF.…”

Section: Statin Therapy and Scdmentioning

confidence: 99%

Statins and sudden cardiac death - mini review on available data

Sosnowska¹,

Banach²

2017

Heart Beat

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“…A recent meta-analysis of 15 prospective studies (n=45,110) addressed the effects of statins in patients with HF [88]. The study included patients with both preserved and reduced EF and showed a reduction in all-cause mortality in patients treated with statins (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.61-0.83) and a reduction in rehospitalization rate for HF (RR 0.84, 95% CI 0.74-0.96) [88].…”

Section: Emerging Treatmentsmentioning

confidence: 99%

Stiff Heart and Stiff Arteries. Could We Soften Both?

Athyros¹,

Τζιόμαλος²,

Farganis³

et al. 2013

TOHYPERJ

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Abstract:Old age, female gender, hypertension (HTN), cardiac ischaemia, and arterial stiffness (AS) are the main determinants of a stiff heart, diastolic dysfunction (DD), and finally heart failure with preserved ejection fraction (HFpEF); however, several cardiac or extra-cardiac pathologies may also be involved. The combined ventricular-arterial stiffening (abnormal left ventricle-arterial coupling) is the main determinant of the increased prevalence of HFpEF in elderly persons, particularly women, and in younger subjects with HTN. Hospitalization and mortality rates in patients with HFpEF are similar to those of patients with heart failure with reduced EF (HFrEF). However, although the prognosis of HFrEF has improved over time, the optimal treatment of HFpEF remains unclear, because of the differences in the pathophysiology of the two syndromes. A number of new drugs have shown promise but they will not be commercially available for several years. For the time being, aggressive treatment of non-cardiac comorbidities is the only option available for the management of HFpEF. Treatment of anaemia, sleep disorders, chronic kidney disease, non-alcoholic fatty liver disease, atrial fibrillation, diabetes mellitus, and judicious use of diuretics are effective to some degree. Statin treatment deserves special attention, regardless of the presence of dyslipidaemia, because it has been shown, mainly in small studies, post hoc analyses, and in a large recent meta-analysis, that it is related to an improved quality of life and a reduction in HF-related mortality. We urgently need to utilize these recourses to relieve a substantial number of patients suffering from HFpEF, a disease with an ominous prognosis.

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Long-term Clinical Outcomes of Statin Use for Chronic Heart Failure: A Meta-analysis of 15 Prospective Studies

Abstract: Based on the available data, statins persistently decreased all-cause mortality and the incidence of rehospitalisation for heart failure in CHF patients, and the benefits might be partially associated with use of specific statin.

Cited by 36 publications

References 39 publications

Treating Heart Failure With Preserved Ejection Fraction

Treating Heart Failure With Preserved Ejection Fraction

Statins and sudden cardiac death - mini review on available data

Stiff Heart and Stiff Arteries. Could We Soften Both?

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