Chicago, IL - Patients with heart failure who start taking statins, compared with those who don't, will live longer and have a lower hospitalization risk regardless of cholesterol levels, presence or absence of coronary disease, and other CV drug therapies, according to one of the largest-yet studies of its kind [1].

Risk reductions in the analysis of more than 24 000 patients with no prior statin exposure are more modest than those in earlier studies of statins in HF, lead author Dr Alan S Go (Kaiser Permanente of Northern California, Oakland) told heartwire. But, he said, the earlier findings were typically from selected groups of HF patients who often had advanced disease, in contrast to his study's broad population that included a large proportion with mild to moderate heart failure.

In their analysis, statin therapy was associated with 24% and 21% declines in the adjusted risks of all-cause mortality and HF hospitalization, respectively. Such outcomes may come close to what can be expected of the drugs should ongoing randomized trials show clinical gains in patients with HF, Go said. "If you're going to treat a whole heart-failure population, this may more reflect the average benefit that you would see." The group's report appears in the November 1, 2006 issue of the Journal of the American Medical Association.

The current analysis included all adults diagnosed with HF from 1996 to 2004 within the Kaiser Permanente of Northern California system who had not previously been exposed to statins but were eligible for them according to National Cholesterol Education Program guidelines. The risk reductions among those starting on the drugs at any point during the follow-up period, which lasted a median of 2.4 years, were independent of a long list of conditions and medications that could have influenced outcomes.

That the analysis controlled for other medications often taken by patients on statins, observed Go, shows that the risk reductions "weren't just reflections of more aggressive treatment of heart failure." The finding of benefit regardless of whether CAD was present, he said, is consistent with other research suggesting that the mechanisms of any statin benefits in HF go beyond lipid modification to include, for example, improved endothelial function or reduction of inflammation.

The clinical trials that established statins' current prominence in CHD prevention and therapy typically excluded patients with HF, according to Go. But "if a person meets current criteria for [statin] treatment, and [has] heart failure, I think we ought to feel comfortable giving it," he said. And, "if they have coronary disease complicated by heart failure, they ought to be treated."

Whether other HF patients should get the drugs is unknown, even with the current analysis, Go said. "We need to wait for those trials to be completed." His team's report mentions two ongoing randomized, placebo-controlled statin HF trials: the Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA), and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca—Heart Failure (GISSI-HF) trials.