Background: Although there is definite evidence that statins help prevent ischemic cardiac events and death, their role in heart failure is less established. Theoretically, they may have a beneficial effect by inducing angiogenesis and other effects, but they also could indirectly impair cardiac muscle or interfere with medications used to treat heart failure. Go and colleagues sought to determine whether statins were associated with negative outcomes in patients with heart failure who were eligible for lipid-lowering therapy.

The Study: Patients from the Kaiser Permanente Chronic Heart Failure cohort were included based on diagnostic criteria relating to hospitalizations and emergency department visits, with heart failure as a primary or secondary diagnosis. The study focused on patients who met the criteria for lipid-lowering therapy but were not receiving statins at entry.

The authors controlled for concomitant cardiac medication use, demographic factors, and comorbidities. Information on outpatient lipid measurements, kidney function, systolic cardiac function, and number of visits to a cardiologist before study entry was obtained. Primary outcomes included all-cause mortality and hospitalization for heart failure.

Results: Of 24,598 eligible patients with heart failure who were not previously on statins, 12,648 (51.4 percent) initiated statin therapy. Prevalence of known coronary heart disease (CHD), diabetes, and hypertension was greater in patients prescribed statins than those not prescribed statins, as were higher levels of low-density lipoprotein and total cholesterol but not high-density lipoprotein.

The statin group visited a cardiologist more often before and after study entry; they also were more likely to use other medications affecting cardiac function. Among those tested for left ventricular function, there was no difference in the prevalence of systolic function in the two groups. In the 2.4 years (median) of follow-up, the rate of death in statin users was 14.5 per 100 person-years compared with 25.3 per 100 person-years in nonstatin users. Hospitalization rates for heart failure in statin and nonstatin users were 21.9 versus 31.1 per 100 person-years, respectively.

Multivariate analysis adjusting for group differences showed a 24 percent reduction in relative risk of death and a 21 percent reduction in relative risk of hospitalization for heart failure among statin users. The adjusted hazard ratio from a secondary analysis associating statin use and risk of death was 0.66 for patients with CHD and 0.60 in those without CHD.

Conclusion: The authors conclude that, despite the theoretical risks associated with statin use, it is associated with lower all-cause mortality and hospitalization for heart failure in patients with heart failure who are eligible for lipid-lowering therapy. This effect was demonstrated in a large, diverse population and persisted regardless of whether patients had CHD or were receiving concomitant therapies. Because the mechanism leading to this effect may be unrelated to cholesterol elevation, further trials are needed to determine whether all heart failure patients would benefit from statin use.