Statins and symptomatic chronic systolic heart failure: A post-hoc analysis of 5010 patients enrolled in Val-HeFT
Introduction
Statin therapy may be of potential benefit in patients with chronic heart failure (CHF) via reduction of coronary events through plaque stabilisation and restoration of endothelial function [1]. Even in patients who do not have CHF of an ischaemic etiology, pre-clinical studies have supported direct improvements in cardiac myocyte function, possibly via neo-vascularisation, down-regulation of angiotensin II (AT1) receptors, restoration of autonomic function and inhibition of pro-inflammatory cytokines [2].
However, there are also patho-physiological reasons why statins may not be of benefit in this setting [2].
Very few studies have reported efficacy and/or outcome of statins in CHF patients and all of those studies were non-randomised or post-hoc analyses of large clinical trial datasets [3], [4], [5].
Therefore, the objective of the present study was to assess the outcome of patients enrolled in the Valsartan Heart Failure Trial (Val-HeFT) [6] according to statin use at the time of randomisation to the angiotensin receptor blocker (ARB) valsartan or placebo.
Section snippets
Methods
This was a retrospective, post-hoc analysis of the Val-HeFT dataset. Details of the overall Val-HeFT results have been published elsewhere [6]. Baseline characteristics of patients on statin compared to the remainder of the population were analysed using Chi Square or Wilcoxon analysis, as appropriate. Baseline laboratory values and changes from baseline to endpoint were analyzed by analysis of covariance for ranks (Rank ANCOVA), adjusted for demographic, echocardiographic and clinical
Baseline characteristics
Baseline characteristics of the patient population are summarised in Table 1. Of the 5010 randomised patients in Val-HeFT, 1602 (32%) were taking a statin at randomisation. Patients on statins at randomisation were younger, with fewer females, fewer NYHA class III-IV, more with ischaemic etiology, lower LVIDd/BSA, higher BMI, slightly lower systolic blood pressure and more diabetics. Statin treated patients were receiving more beta-blockers. Patients on statins at baseline had lower total
Discussion
The present analysis has examined a large cohort of patients with systolic CHF for mortality and morbidity/mortality outcomes according to statin use at baseline. To our knowledge this is the largest non-randomised sample of patients with CHF ever studied in this way.
We observed lower mortality (− 19%) and morbidity/mortality (− 15%) in patients taking statins at randomisation in Val-HeFT compared to no statin patients. Particular benefit was observed in Val-HeFT patients of ischaemic etiology to
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