Statins in the Treatment of Heart Failure
2010; Lippincott Williams & Wilkins; Volume: 3; Issue: 3 Linguagem: Inglês
10.1161/circheartfailure.110.956342
ISSN1941-3297
AutoresPim van der Harst, Rudolf A. de Boer,
Tópico(s)Pharmaceutical Economics and Policy
ResumoHomeCirculation: Heart FailureVol. 3, No. 3Statins in the Treatment of Heart Failure Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBStatins in the Treatment of Heart Failure Pim van der Harst, MD and Rudolf A. de Boer, MD Pim van der HarstPim van der Harst From the Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. and Rudolf A. de BoerRudolf A. de Boer From the Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Originally published1 May 2010https://doi.org/10.1161/CIRCHEARTFAILURE.110.956342Circulation: Heart Failure. 2010;3:462–464The 3-hydroxy-3-methylglutaryl coenzyme-A inhibitors or statins have been shown to reduce morbidity and mortality in patients with coronary artery disease or those at increased risk of coronary artery disease (Table). Consequently, statin therapy has become the cornerstone treatment in primary and secondary prevention of coronary artery disease for almost every patient category. However, the case for the use of statin therapy in the most advanced stage of the cardiovascular disease continuum, namely patients with chronic heart failure (CHF) has been disputed. Until recently, we simply lacked data because patients with CHF had been systematically excluded from large clinical statin trials (Table).16 Although a few smaller, uncontrolled trials suggested that statins may be beneficial in CHF too, there is some reason to think that statins may rather have harmful effects in patients with CHF.17 Recently, the long-awaited CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure] and the GISSI-HF [Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Heart Failure] trials were completed.13,14 These trials prospectively investigated the use of rosuvastatin 10 mg daily, specifically in patients with CHF. Both trials failed to demonstrate a beneficial effect of statin treatment on their primary end point (Table). In addition, a post-hoc analysis of the Heart Protection Study and the CORONA trial revealed a decreased benefit of statin treatment in subjects with higher N-terminal pro-B-type natriuretic peptide levels.18,19 The most recent guidelines on the treatment of CHF, based on the results of the CORONA trial, have classified the use of statin treatment as a IIb recommendation based on level B evidence.20 However, the results of the GISSI-HF were not taken into consideration because they were not available at that time.Table. Clinical Outcome in Large (N>2500), Placebo-Controlled Statin Trials and Patients With CHF in These TrialsTrial Acronym, YearNo. of PatientsIntervention*PreventionConclusionPatients With CHF4S, 199414444Simva 10 to 40SecondaryLong-term treatment with simvastatin is safe and improves survival in patients with coronary heart disease.ExcludedWOSCOPS, 199526595Prava 40PrimaryPravastatin significantly reduced the incidence of myocardial infarction and death from cardiovascular causes without adversely affecting the risk of death from noncardiovascular causes in men with moderate hypercholesterolemia and no history of myocardial infarction.ExcludedCARE, 199634159Prava 40SecondaryThe benefit of pravastatin treatment reduced the occurrence of fatal coronary events and nonfatal myocardial infarction in patients with coronary disease who had average cholesterol levels.Symptomatic CHF excludedAFCAPS/TexCAPS, 199846605Lova 20 to 40PrimaryLovastatin reduces the risk for the first acute major coronary event in men and women with average cholesterol levels and below average HDL-C levels.ExcludedLIPID, 199859014Prava 40SecondaryPravastatin therapy reduced mortality from coronary heart disease and overall mortality, as well as the incidence of all prespecified cardiovascular events in patients with a history of myocardial infarction or unstable angina who had a broad range of initial cholesterol levels.Symptomatic CHF excludedMIRACL, 200163086Atorva 80SecondaryAtorvastatin treatment reduces recurrent ischemic events in patients with acute coronary syndromes.Excluded NYHA IIIb/IV. No difference in worsening heart failureMRC/HPS, 2002720 536Simva 40SecondaryAdding simvastatin to existing treatments safely produces substantial additional benefits for a wide range of high-risk patients, irrespective of their initial cholesterol concentrations.Severe heart failure excludedPROSPER, 200285804Prava 40Primary/SecondaryPravastatin reduced the risk of coronary disease in elderly individuals.Excluded NYHA III/IV. No difference in CHF hospitalization.ASCOT-LLA, 2003910 305Atorva 10PrimaryLarge reduction in major cardiovascular events with atorvastatin in hypertensive patients with at least 3 other cardiovascular risk factors.ExcludedCARDS, 2004102838Atorva 10PrimaryAtorvastatin reduces the risk of first cardiovascular disease events, including stroke, in patients with type 2 diabetes without high LDL-cholesterol.ExcludedPACT, 2004113408Prava 20 to 40Secondary (HTx pts)Pravastatin administred within 24 hours of the onset of symptoms of an acute coronary event had no significant favorable trend in outcome at 30 days.Not reportedSPARCL, 2003124731Atorva 80SecondaryIn patients with recent stroke or TIA and without known coronary heart disease, atorvastatin treatment reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke.ExcludedCORONA, 200713±5000Rosuva 10SecondaryRosuvastatin did not reduce the primary outcome or No. of deaths from any cause in older patients with systolic heart failure, although the drug did reduce the No. of cardiovascular hospitalizations. The drug did not cause safety problems.Included NYHA II–IV, LVEF <40%.GISSI-HF, 200814±5000Rosuva 10SecondaryRosuvastatin did not affect clinical outcomes in patients with CHF of any cause, in whom the drug was safe.Included NYHA II to IVJUPITER, 20081517 802Rosuva 20PrimaryIn apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events.ExcludedThe CORONA and the GISSI-HF trial that are represented in the table were conducted specifically in heart failure patients and showed different result from trials in other patient categories. Simva indicates simvastatin; Prava, pravastatin; Lova, lovastatin; Atorva, atorvastatin; Rosuva, rosuvastatin; HTx, heart transplantation; TIA, transient ischemic attack; LDL, low-density lipoprotein.*Statin dose is in mg/day.Do the results of the CORONA and the GISSI-HF trial preclude the initiation of statin treatment when a patient has progressed beyond a certain threshold in the cardiovascular disease continuum? Should we weigh in causes, N-terminal pro-B-type natriuretic peptide levels, lipid levels, and vascular comorbidity in our decision? Or alternatively, do we now have enough evidence to reduce polypharmacy and costs, and is it good clinical practice to discontinue statin treatment in majority of patients with CHF, even of ischemic cause, hyperlipidemia, or with vascular comorbidities? Either way, we may be in need for a straightforward, randomized trial with patients with CHF testing whether discontinuation of statin treatment is the best practice.Sources of FundingDr van der Harst was supported by the Netherlands Organisation for Health Research and Development grand 920-03-236.DisclosuresNone.FootnotesCorrespondence to Dr P. van der Harst, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands. E-mail p.van.der.[email protected]umcg.nlReferences1. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994; 344:1383–1389.MedlineGoogle Scholar2. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, Macfarlane PW, McKillop JH, Packard CJ, for The West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. 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Eur J Heart Fail. 2008; 10:933–989.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Wallach-Kildemoes H, Stovring H, Holme Hansen E, Howse K and Pétursson H (2015) Statin prescribing according to gender, age and indication: what about the benefit-risk balance?, Journal of Evaluation in Clinical Practice, 10.1111/jep.12462, 22:2, (235-246), Online publication date: 1-Apr-2016. Rahman A, Jafry S, Jeejeebhoy K, Nagpal A, Pisani B and Agarwala R (2015) Malnutrition and Cachexia in Heart Failure, Journal of Parenteral and Enteral Nutrition, 10.1177/0148607114566854, 40:4, (475-486), Online publication date: 1-May-2016. Barrett-O'Keefe Z, Lee J, Berbert A, Witman M, Nativi-Nicolau J, Stehlik J, Richardson R and Wray D (2014) Hemodynamic responses to small muscle mass exercise in heart failure patients with reduced ejection fraction, American Journal of Physiology-Heart and Circulatory Physiology, 10.1152/ajpheart.00527.2014, 307:10, (H1512-H1520), Online publication date: 15-Nov-2014. Udelson J (2010) Editor's Note, Circulation: Heart Failure, 3:3, (459-459), Online publication date: 1-May-2010. Ryzhman N, Grishaev S, Cherkashin D, Gladysheva E, Filippov V and Kutelev G (2020) Effect of atorvastatin on the lipid profile, markers of immune inflammation and symptomatic severity of heart failure in patients with myocarditis, Bulletin of the Russian Military Medical Academy, 10.17816/brmma50538, 22:3, (76-81) May 2010Vol 3, Issue 3 Advertisement Article InformationMetrics © 2010 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.110.956342PMID: 20484198 Originally publishedMay 1, 2010 Keywordsheart failurePDF download Advertisement SubjectsHeart Failure
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