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
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Figure 1 Cumulative incidence of the hospitalization for congestive heart failure. Intensive statin therapy with atorvastatin 80 mg, as compared with moderate statin therapy with pravastatin 40 mg, reduced the risk for hospitalization for congestive heart failure by 45% (hazard ratio 0.55, 95% confidence interval 0.35 to 0.85, p = 0.008). This benefit was not attenuated after controlling for recurrent myocardial infarction (MI) or prior history of heart failure.
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Figure 2 Cumulative incidence of hospitalization for congestive heart failure stratified into four groups: 1) patients with normal baseline levels of B-type natriuretic peptide (BNP) (<80 ng/l) on atorvastatin; 2) patients with normal BNP on pravastatin; 3) patients with elevated levels of BNP (>80 ng/l) on atorvastatin; and 4) patients with elevated BNP on pravastatin. Comparisons between groups were performed using a Cox proportional hazard model that included age, gender, diabetes mellitus, hypertension, smoking, body mass index, creatinine, index event, percutaneous coronary intervention for index event. Among patients with elevated levels of BNP, treatment with atorvastatin significantly reduced the risk of heart failure. *Hazard ratio (HR) 6.9, 95% confidence interval (CI) 3.3 to 14.4, p < 0.001 compared with BNP <80/atorvastatin; **HR 2.2, 95% CI 0.85 to 5.9, p = 0.115 compared with BNP <80/atorvastatin; ***HR 1.7, 95% CI 0.90 to 3.4, p = 0.099 compared with BNP <80/atorvastatin; HR 0.32, 95% CI 0.13 to 0.8, p = 0.014 compared with BNP >80/pravastatin.
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Figure 3 Benefit of intensive statin therapy versus moderate statin therapy in reducing the risk of hospitalization for heart failure in 27,546 patients. This analysis includes the Pravastatin or Atorvastatin Evaluation and Infection Trial–Thrombolysis In Myocardial Infarction 22 (PROVE IT–TIMI 22) (1), Treating to New Targets (TNT) (2), A to Z (11), and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) (3) studies.
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