JACC: Statins may prevent heart failure deaths

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Statin use was associated with a 26% decrease in relative risk of heart failure death, benefitting patients with both ischemic and non-ischemic heart failure, according to the Jan. 29 issue of the Journal of the American College of Cardiology.

Douglas L. Mann, MD, of Baylor College of Medicine, and colleagues conducted a meta-analysis that found that the hazard ratio for death with statin therapy in ischemic heart failure was 0.73, which was identical for patients with non-ischemic heart failure
Despite their findings, the researchers did not recommend the use of statins in heart failure treatment guidelines.

The researchers examined pooled data from 13 published clinical studies, covering 131,430 patients, 30,107 of whom received statins.
The meta-analysis showed that 18.7% of the placebo users died during the studies, compared with 15.6% of the statin users, which translates into a 22% lower mortality risk for high-risk patients older than 65.

“Of note, the improved mortality was seen when statins were added to currently recommended therapy for heart failure,” the authors wrote.

Their findings contradict with those of the prospective, 5,000-patient CORONA study, which found no significant mortality benefit for rosuvastatin (Crestor) in heart failure, the researchers noted.

Though Mann and his colleagues included the data from the CORONA study, the researchers said they could not definitively account for the discrepancy between CORONA and the other studies in the meta-analysis. However, they wrote it could stem from specific properties of Crestor, patient selection in CORONA or a lack of true treatment benefits for the statin class.

The meta-analysis also appears to refute the concept that statins could be harmful to heart failure patients. The researchers cited a theory that high cholesterol levels are actually protective in heart failure because cholesterol molecules detoxify bacterial endotoxins.

Mann and colleagues reviewed possible biochemical mechanisms for statins' beneficial effects in heart failure. The drug primarily targets 3-hydroxy-3-methylglutaryl coenzyme A reductase as more than just a component in the cholesterol biosynthesis pathway, they wrote.

“It is premature to recommend the routine use of statins for the treatment of patients with heart failure outside of current practice guidelines for the treatment of coronary artery disease,” because of its conflicting results with previous trials, the authors wrote.

The researchers highlighted an ongoing prospective trial, GISSI-HF, which “should provide additional insight into whether statins will add to currently recommended heart failure therapy.”