Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure

Department of Medicine, University of California, San Francisco, San Francisco, California, United States
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 12/2006; 296(17):2105-11. DOI: 10.1001/jama.296.17.2105
Source: PubMed

ABSTRACT Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear.
To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure.
Propensity-adjusted cohort study of adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had no previous known statin use, within an integrated health care delivery system in northern California between January 1, 1996, and December 31, 2004. Statin use was estimated from filled outpatient prescriptions in pharmacy databases.
All-cause death and hospitalization for heart failure during a median of 2.4 years of follow-up. We examined the independent relationships between statin therapy and risks for adverse events overall and stratified by the presence or absence of coronary heart disease after multivariable adjustment for potential confounders.
Among 24,598 adults diagnosed with heart failure who had no prior statin use, those initiating statin therapy (n = 12,648; 51.4%) were more likely to be younger, male, and have known cardiovascular disease, diabetes, and hypertension. There were 8235 patients who died. Using an intent-to-treat approach, incident statin use was associated with lower risks of death (age- and sex-adjusted rate of 14.5 per 100 person-years with statin therapy vs 25.3 per 100 person-years without statin therapy; adjusted hazard ratio, 0.76 [95% confidence interval, 0.72-0.80]) and hospitalization for heart failure (age- and sex-adjusted rate of 21.9 per 100 person-years with statin therapy vs 31.1 per 100 person-years without statin therapy; adjusted hazard ratio, 0.79 [95% confidence interval, 0.74-0.85]) even after adjustment for the propensity to take statins, cholesterol level, use of other cardiovascular medications, and other potential confounders. Incident statin use was associated with lower adjusted risks of adverse outcomes in patients with or without known coronary heart disease.
Among adults diagnosed with heart failure who had no prior statin use, incident statin use was independently associated with lower risks of death and hospitalization among patients with or without coronary heart disease.

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    • "Although statins have not been administered routinely to HF patients, clinical trials have shown that statin therapy is effective in the prognosis of HF. In the Kaiser Permanente Chronic Heart Failure cohort, statin therapy was associated with a lower relative risk of death and hospitalization for HF [4]. Statin therapy was associated with improvements in mortality in older patients with HF [5]. "
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    ABSTRACT: Statins decrease serum levels of low-density lipoprotein (LDL) cholesterol and have pleiotropic effects. Statin therapy may have beneficial effects on the clinical outcome in patients with heart failure (HF). HF is associated with lipoprotein components. A recent study suggested that lower levels of high-density lipoprotein (HDL) cholesterol were the strongest predictor of worsening HF. In addition, serum total cholesterol (TC) is a prognostic factor for patients with HF. Although the levels of HDL cholesterol, apolipoprotein (Apo) A-I, triglyceride, TC, and LDL cholesterol may be associated with the onset of HF and/or an adverse prognosis in patients with HF, it is not yet clear which lipoprotein plays the most important role in this context. Among these lipoproteins, HDL protects against cardiovascular events by mediating the enhancement of reverse cholesterol transport. Moreover, HDL also has pleiotropic effects, such as anti-oxidant, anti-inflammatory, and anti-thrombotic properties. An increase in HDL cholesterol or ApoA-I, the principal Apo of HDL, may be a therapeutic target in HF. Therefore, we discuss here the usefulness of statins and lipoprotein metabolism for preventing HF.
    Journal of Cardiology 03/2010; 55(3):287-90. DOI:10.1016/j.jjcc.2010.02.003 · 2.57 Impact Factor
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    • "After adjustment for differences in baseline clinical variables and drug used, the association of statin therapy with lower mortality remained significant (P!.001). Observational studies of statins in heart failure including diastolic heart failure Mortality benefit of statins has been shown in four recent observational studies that included diastolic heart failure [23] [24] [25] [26]. Specifically, Folkeringa and colleagues [23] conducted a retrospective case-control study in a total cohort of 840 heart failure patients admitted to the University Hospital Maastricht in the Netherlands between 1998 and 2000. "
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    ABSTRACT: This article reviews the available evidence from observational studies concerning the effect of statin therapy in patients who have heart failure and a preserved ejection fraction (diastolic heart failure). Observational studies suggest that statin therapy is associated with lower mortality in patients who have diastolic heart failure. These results emphasize the need for a randomized study of the effect of statins in diastolic heart failure. Until the results of such studies are available, it is recommended to use statins in patients with diastolic heart failure who otherwise have an indication for statin therapy.
    Heart Failure Clinics 05/2008; 4(2):209-16. DOI:10.1016/j.hfc.2008.01.005 · 1.41 Impact Factor
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    • "Another study showed that atorvastatin, even at low doses, reduced cytokine levels [33]. Go and colleagues recently reported that incident statin use in patients with heart failure (with or without coronary artery disease) who had not previously taken statins was independently associated with a lower risk of hospitalization and death [34]. Nevertheless, statin use in heart failure has potential disadvantages. "
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    ABSTRACT: Treatment of pediatric heart failure is challenging because of the heterogeneity in etiology and the lack of extensive, standardized guidelines. Many current treatment regimens are based on anecdotal evidence or experience in adult populations. Mortality rates can be high in children with heart failure, and studies of treatment strategies for improving outcome are ongoing. Newer strategies for pediatric populations may involve optimizing established regimens that have been successful in adults or validating alternative intravenous therapies, such as levosimendan and nesiritide, which have shown promise in early studies. As the technology continues to improve, ventricular assist devices are being used more frequently in children. Studies are underway to evaluate the success of cardiac resynchronization therapy in children with ventricular dyssynchrony. In addition, indirect strategies that target other organ systems may improve cardiac function in a global approach to treating pediatric patients. This article will summarize current therapies and present options for newer treatment strategies for the increasing population of children with heart failure.
    Progress in Pediatric Cardiology 09/2007; DOI:10.1016/j.ppedcard.2007.05.004
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