EXPEDITED REVIEW
Intensive Statin Therapy and the Risk of Hospitalization for Heart Failure After an Acute Coronary Syndrome in the PROVE IT–TIMI 22 Study
Benjamin M. Scirica, MD, MPH*,*,
David A. Morrow, MD, MPH*,
Christopher P. Cannon, MD*,
Kausik K. Ray, MD*,
Marc S. Sabatine, MD, MPH*,
Petr Jarolim, MD, PhD ,
Amy Shui, BS*,
Carolyn H. McCabe, BS*,
Eugene Braunwald, MD* for the PROVE IT–TIMI 22 Investigators
* TIMI Study Group, Cardiovascular Division, Department of Medicine, Boston, Massachusetts
Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
Manuscript received January 25, 2006;
revised manuscript received March 8, 2006,
accepted March 16, 2006.
* Reprint requests and correspondence: Dr. Benjamin M. Scirica, TIMI Study Group, 350 Longwood Avenue, 1st Floor, Boston, Massachusetts 02115 (Email: bscirica{at}partners.org).
OBJECTIVES: We aimed to determine whether intensive statin therapy reduces hospitalization for heart failure (HF) in high-risk patients.
BACKGROUND: While the relationship between intensive statin therapy and ischemic events is well established, its relationship to the risk of HF after an acute coronary syndrome (ACS) is not well defined.
METHODS: The Pravastatin or Atorvastatin Evaluation and Infection Trial–Thrombolysis In Myocardial Infarction 22 (PROVE IT–TIMI 22) study randomized 4,162 patients, stabilized after ACS, to either intensive statin therapy (atorvastatin 80 mg) or moderate statin therapy (pravastatin 40 mg). Hospitalization for HF occurring more than 30 days after randomization was determined during a mean follow-up of 24 months. B-type natriuretic peptide (BNP) levels were measured at baseline (median seven days after randomization).
RESULTS: Treatment with atorvastatin 80 mg significantly reduced the rate of hospitalization for HF (1.6% vs. 3.1%, hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.35 to 0.85, p = 0.008) independently of a recurrent myocardial infarction or prior history of HF. The risk of HF increased steadily with increasing quartiles of BNP (HR 2.6, 95% CI 1.2 to 5.5, p = 0.016 for the highest quartile compared with the lowest). Among patients with elevated levels of BNP (>80 pg/ml), treatment with atorvastatin significantly reduced the risk of HF compared with pravastatin (HR 0.32, 95% CI 0.13 to 0.8, p = 0.014). A meta-analysis of four trials that included 27,546 patients demonstrates a 27% reduction in the odds of hospitalization for HF with intensive statin therapy.
CONCLUSIONS: Intensive statin therapy reduces the risk of hospitalization for HF after ACS with the most gain in patients with elevated levels of BNP.
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Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | BNP = B-type natriuretic peptide | | CI = confidence interval | | HR = hazard ratio | | OR = odds ratio |
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