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Lipid-Lowering Therapy and Outcomes in Heart Failure

Department of Medicine, Divisions of General Internal Medicine and Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada, rayj{at}smh.toronto.on.ca

Colleen M. Norris, PhD

Nursing and Divisions of Cardiology and Cardiovascular Surgery, University of Alberta, Edmonton, Alberta, Albeta, Canada

Jacob A. Udell, MD, MPH

Department of Medicine, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada

Ross T. Tsuyuki, PharmD, MSc, FCSHP, FACC

Division of Cardiology, EPI-CORE Centre, University of Alberta, Edmonton, Alberta, Alberta, Canada

Finlay A. McAlister, MD, MSc, FRCPC

Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Alberta, Canada

Merril L. Knudtson, MD, FRCPC

Department of Cardiac Sciences, University of Alberta, Edmonton, Alberta, Alberta, Canada

William A. Ghali, MD, MPH, FRCPC

Department of Medicine, Community Health Sciences and Centre for Health and Policy Studies, University of Alberta, Edmonton, Alberta, Alberta, Canada

Lipid-lowering therapy, particularly with statins, reduces the risk of cardiovascular mortality; however, there is uncertainty about their efficacy in patients with heart failure, including those without coronary artery stenosis. A clinical database was studied to determine whether lipid-lowering therapy is associated with improved survival in persons with heart failure—with or without concomitant coronary artery stenosis. During an 8-year period, 6060 people with a history of heart failure underwent coronary angiography. At the time of angiography, 1216 received a lipid-lowering agent. During a median follow-up of 4.7 years, 7.1 deaths per 100 person-years occurred among users of lipid-lowering therapy, compared with 7.8 per 100 person-years among nonusers (adjusted hazard ratio 0.87, 95% confidence interval 0.77-0.97). Use of lipid-lowering therapy was associated with a reduced risk of death in patients with heart failure. Current evidence supports statin use in individuals with recognized heart failure and concomitant coronary heart disease, dyslipidemia, or diabetes mellitus. More data are needed before statins can be recommended in those with isolated heart failure.

Key Words: statin • heart failure • death • mortality • arrhythmia • acute myocardial infarction • stroke • atorvastatin • pravastatin • simvastatin

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 12, No. 1, 27-35 (2007)
DOI: 10.1177/1074248407299839


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