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J Am Coll Cardiol, 2007; 49:1372, doi:10.1016/j.jacc.2007.01.012 (Published online 7 March 2007).
© 2007 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Is There a Statin Effect on Arrhythmia and Survival in Patients With Nonischemic Cardiomyopathy?

Neil L. Coplan, MD, FACC* and Mark Ramos, MD

* Division of Cardiovascular Medicine, Lenox Hill Hospital, 100 East 77th Street, New York, New York 10021 (Email: ncoplan{at}lenoxhill.net).

Goldberger et al. (1), authors of "Effects of Statin Therapy on Arrhythmic Events and Survival in Patients with Nonischemic Dilated Cardiomyopathy", note that the data "strongly suggests that statins may improve mortality in patients with nonischemic cardiomyopathies." Although an association has been demonstrated between statin use and survival, it will take more data before an effect can be attributed to statin therapy. The fact that there is no significant difference in the number of appropriate implantable cardioverter-defibrillator (ICD) shocks between patients treated with statins and those not treated with statins does not support the concept that statins have a pleiotropic antiarrhythmic effect.

Another factor that needs to be considered is whether statin therapy in this study is just a marker for a better prognosis. Although data are not presented, it is presumed that patients on statin therapy had higher cholesterol. Studies (2,3) have shown that higher serum total cholesterol is independently associated with a better prognosis in patients with heart failure. Patients without statin therapy may have had poor nutrition or some other type of medical problem related to poor survival (4). It would be interesting to know the albumin levels or other measures of general nutrition in the statin and nonstatin groups.

The investigators (1) note in the limitations section of their study that it is highly implausible to assume that hypercholesterolemia selects a patient population at markedly lower risk. Rather than dismissing this relationship, the inverse relationship between heart failure mortality and cholesterol level should be considered in any future study of possible statin effect.


   References
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 References
 

  1. Goldberger JJ, Subacius H, Schaechter A, et al. Effects of statin therapy on arrhythmic events and survival in patients with nonischemic dilated cardiomyopathy J Am Coll Cardiol 2006;48:1228-1233.[Abstract/Free Full Text]
  2. Rauchhaus M, Clark AL, Doehner W, et al. The relationship between cholesterol and survival in patients with chronic heart failure J Am Coll Cardiol 2003;42:1933-1940.[Abstract/Free Full Text]
  3. Horwich TB, Hamilton MA, MacLellan WR, Fonarow GC. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure J Card Fail 2002;8:216-224.[CrossRef][ISI][Medline]
  4. Anker SD, Ponikowski P, Varney P, et al. Wasting as independent risk factor for mortality in chronic heart failure Lancet 1997;349:1050-1053.[CrossRef][ISI][Medline]

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Is There a Statin Effect on Arrhythmia and Survival in Patients With Nonischemic Cardiomyopathy?
Neil L. Coplan and Mark Ramos
J. Am. Coll. Cardiol. 2007 49: 1372. [Full Text] [PDF]

Reply
Jeffrey J. Goldberger and Alan H. Kadish
J. Am. Coll. Cardiol. 2007 49: 1372. [Full Text] [PDF]




This Article
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j.jacc.2007.01.012v1
49/12/1372    most recent
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