Impact of statin use on clinical outcomes in patients with heart failure

Takeaway

• Statin treatment was associated with reduction in all-cause mortality, cardiovascular (CV) mortality and CV hospitalisation in heart failure (HF) with either left ventricular ejection fraction (LVEF) ≥40% or LVEF<40%.
• Lipophilic statins might be more favourable than hydrophilic statins for patients with HF.

Why this matters

• The role of statins in patients with HF and different LVEF levels remains unclear, particularly because of the lack of data from randomised trials in non-ischaemic HF and taking into account potential prosarcopenic effects of statins.

Study design

• Meta-analysis of 17 studies (n=88,100) compared the effects of statin (n=42,400) vs non-statin therapy (n=45,700) on clinical outcomes in patients with HF.
• Primary outcomes: all-cause mortality and CV mortality and hospitalisation.
• Funding: None.

Key results

• Statin vs non-statin users were significantly at lower risk for:
  • all-cause mortality (HR, 0.77; 95% CI, 0.72-0.83; P<.0001; I²=63%) and
  • CV mortality (HR, 0.82; 95% CI, 0.76-0.88; P<.00001; I²=63%) and hospitalisation (HR, 0.78; 95% CI, 0.69-0.89; P=.0003).
• Compared with non-statin users, statin users with both EF <40% and ≥40% had lower risk for all-cause mortality (HR, 0.77; 95% Cl, 0.68-0.86; I²=71% and HR, 0.75; 95% Cl, 0.69-0.82; P<.00001 for both).
• Similarly, the risk for CV mortality (HR, 0.83; 95% CI, 0.77-0.90; I²=55%; P<.00001 and HR, 0.86; 95% CI, 0.79-0.93; P=.0003, respectively) and hospitalisations (HR, 0.80; 95% CI, 0.64-0.99; P=.04 and HR, 0.76; 95% CI, 0.61-0.93; P=.009; I²=63%, respectively) reduced in both EF groups.
• Lipophilic vs hydrophilic statins significantly decreased:
  • CV mortality (HR 0.79; 95% Cl, 0.74–0.88 vs HR 0.94; 95% Cl, 0.85–1.05),
  • CV hospitalizations (HR 0.60; 95% Cl, 0.45–0.86 vs HR 0.78; 95% Cl, 0.50–1.22).

Limitations

• Heterogeneity among studies.
• Limited data available on compliance with statin therapy or statin dosage.