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CLINICAL RESEARCH: HEART FAILURE

Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure

^* Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California, USA

Manuscript received May 21, 2003; revised manuscript received July 2, 2003, accepted July 28, 2003.

^* Reprint requests and correspondence: Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California at Los Angeles, 47-123 CHS, 10833 Le Conte Avenue, Los Angeles, California 90095-1679, USA.
gfonarow{at}mednet.ucla.edu

OBJECTIVES: This study aimed to investigate the impact of hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) therapy in patients with advanced heart failure (HF).

BACKGROUND: Although statins are known to reduce mortality in coronary artery disease (CAD), the impact of statin therapy in patients with HF has not been well studied. Both the potential risks and benefits of statins in HF have been described.

METHODS: We studied a cohort of 551 patients with systolic HF (left ventricular ejection fraction [EF] 40%) referred to a single university center for clinical management and/or transplant evaluation. Survival without the necessity of urgent heart transplantation was determined.

RESULTS: The patients' mean age was 52 ± 13 years; mean EF was 25 ± 7%. Forty-five percent of the cohort had CAD, and 45% were receiving statin therapy, including 73% and 22% of CAD and non-CAD patients with HF, respectively. Patients receiving statins were significantly older and more likely to be male, with higher rates of hypertension, diabetes, and smoking. The EF and cholesterol levels were similar between treated and non-treated patients. Statin use was associated with improved survival without the necessity of urgent transplantation in both non-ischemic and ischemic HF patients (91% vs. 72%, p < 0.001 and 81% vs. 63%, p < 0.001 at one-year follow-up, respectively). After risk adjustment for age, gender, CAD, cholesterol, diabetes, medications, hemoglobin, creatinine, and New York Heart Association functional class, statin therapy remained an independent predictor of improved survival (hazard ratio 0.41 95% confidence interval 0.18 to 0.94).

CONCLUSIONS: Statin therapy is associated with improved survival in patients with ischemic and non-ischemic HF. Randomized trials are needed for confirmation of a therapeutic benefit.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CAD = coronary artery disease   CI = confidence interval   EF = ejection fraction   eNOS = endothelial nitric oxide synthase   HF = heart failure   HR = hazard ratio   LDL = low-density lipoprotein   NO = nitric oxide

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