The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy – 5-year follow-up

Abstract

BackgroundWe assessed the influence of atorvastatin on selected indicators of an inflammatory condition, left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy (DCM).MethodsWe included 68 DCM patients with left ventricular ejection fraction (LVEF) ≤40% treated optimally in a prospective, randomized study. They were observed for 5 years. Patients were divided into two groups: patients who were commenced on atorvastatin 40 mg daily for two months followed by an individually matched dose of 10 or 20 mg/day (group A), and patients who were treated according to current recommendations without statin therapy (group B).ResultsAfter 5-year follow-up we assessed 45 patients of mean age 59 ± 11 years - 22 patients in group A (77% male) and 23 patients in group B (82% male). Interleukin-6, tumor necrosis factor alpha, and uric acid concentrations were significantly lower in the statin group than in group B (14.96 ± 4.76 vs. 19.02 ± 3.94 pg/ml, p = 0.012; 19.10 ± 6.39 vs. 27.53 ± 7.39 pg/ml, p = 0.001, and 5.28 ± 0.48 vs. 6.53 ± 0.46 mg/dl, p = 0.001, respectively). In patients on statin therapy a reduction of N-terminal pro-brain natriuretic peptide concentration (from 1425.28 ± 1264.48 to 1098.01 ± 1483.86 pg/ml, p = 0.045), decrease in left ventricular diastolic (from 7.15 ± 0.90 to 6.67 ± 0.88 cm, p = 0.001) and systolic diameters (from 5.87 ± 0.92 to 5.17 ± 0.97, p = 0.001) in comparison to initial values were observed. We also showed the significant increase of LVEF in patients after statin therapy (from 32.0 ± 6.4 to 38.8 ± 8.8%, p = 0.016). Based on a comparison of curves using the log-rank test, the probability of survival to 5 years was significantly higher in patients receiving statins (p = 0.005).ConclusionsAtorvastatin in a small dose significantly reduce levels of inflammatory cytokines and uric acid, improve hemodynamic parameters and improve 5-year survival in patients with DCM.

Efekty leczenia atorwastatyną chorych w średnim wieku z zaawansowaną kardiomiopatią rozstrzeniową — prospektywne randomizowane badanie jednoośrodkowe

“…In our study group, 23 patients (24.2%) died due to heart failure over one year, including 12 patients in the study group and 11 patients in the control group. Available literature data indicate that prognosis in patients with clinically overt DCM is poor, with mortality up to 25% at one year and 50% at 5 years [14,[24][25][26][27][28][29]. Our study did not show a beneficial effect of atorvastatin on the clinical endpoints although a nonsignificant reduction in the endpoint rate was observed and it cannot be excluded that these differences might become significant with a longer duration of follow-up.…”

“…According to the current knowledge, development and progression of heart failure depends on neurohormonal activation, inflammation, and adaptive changes in the myocardium known as left ventricular remodelling [26][27][28][29]. These parameters are modulated by the current drug treatment of heart failure.…”

“…Of note, literature data do suggest a beneficial effect of statins on the major pathogenetic mechanisms of heart failure [24][25][26][27][28][29].…”

“…To date, more than 12 gene deletions were identified [11,12,[26][27][28][29]. The proportion of patients with familial DCM in our study was 41.5%; Tomasz Wcisło et al, Effects of atorvastatin treatment in middle-aged patients with advanced idiopathic DCM -immunologic -impaired cellular and humoral immunity manifesting with the presence of specific cardiac autoantibodies and an increase in proinflammatory cytokines such as tumour necrosis factor α (TNFα) which are responsible for systolic dysfunction [26][27][28][29]; -metabolic -obesity is an established cardiovascular risk factor. The Framingham Study showed that an increase in body mass index (BMI) by 1 kg/m 2 is associated with an increased risk of heart failure (by 5% in women and 7% in men), and the risk was increased 2-fold in obese subjects compared to those with normal BMI.…”

Treatment of Chronic Heart Failure With Preserved Left Ventricular Ejection Fraction in Patients With Hypertension Disease: Potential Therapeutic Role of Statines

“…В зна-чительной степени это может быть связано с недостаточ-ной статистической мощностью исследования. Ранее в небольших работах было показано, что аторвастатин снижал уровень маркеров воспаления, улучшал функцию эндотелия и толерантность к физической нагрузке у боль-ных ХСН со сниженной ФВ ЛЖ [29,30]. Однако авторы крупного проекта HF-ACTION (n = 2 331) не получили доказательств улучшения качества жизни и переносимо-сти физической нагрузки при добавлении различных статинов к лечению пациентов с ХСН и сниженной ФВ ЛЖ [31].…”