Statins associated with lower morbidity, mortality in patients with CHF with or without CHD
A large, propensity score-adjusted cohort study recently published in the Journal of the American Medical Association (JAMA) demonstrated that statins were associated with a statistically significant reduction in the risks of death and hospitalization for heart failure when administered to patients with chronic heart failure (CHF). Although the ability of statins to lower cholesterol and prevent coronary heart disease in the general population is well known, the current finding that statins can reduce both morbidity and mortality in this broad CHF population is novel.
Statins are thought to have what are referred to as "pleiotropic" effects-beneficial effects outside of the ability to lower cholesterol. It is hypothesized that these effects, including the ability to reduce levels of inflammatory factors and detrimental cytokines, improve endothelial function, and stabilize coronary plaques, may be particularly beneficial in patients with CHF. However, there has been concern that statin use could have detrimental effects in this population, as well.
Although previous observational studies evaluating statin use in patients with CHF have demonstrated statins' effects in reducing morbidity and mortality, these studies have focused largely on selected subgroups, such as patients who were hospitalized for heart failure, had advanced heart failure, and/or had impaired systolic function, according to the authors. In comparing this study with previous studies, the authors stated, "Our heart failure population was large and sociodemographically diverse and included patients diagnosed with heart failure in both ambulatory and hospital settings."
Although this study provided some evidence that the use of statins in patients with CHF may be beneficial, the authors emphasized that results from the Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA), Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca–Heart Failure (GISSI–HF), and other future randomized, controlled trials would clarify the role of statins in managing CHF, particularly among patients with nonischemic heart failure who are not otherwise recommended to receive lipid-lowering therapy.
SOURCES Go AS, Lee WY, Yang J, Lo JC, Gurwitz JH. Statin therapy and risks for death and hospitalization in chronic heart failure. JAMA. 2006;296:2105–2111.
van der Harst P, Voors AA, van Gilst WH, Bohm M, van Veldhuisen DJ. Statins in the treatment of chronic heart failure: A systematic review. PLoS Med. 2006;3:1403–1413.
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