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Heart failure benefits vary among different statins

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – The benefits of statins are variable and depend on the agent being taken, a meta-analysis has shown.

Pooled data from 10 randomized trials also suggested that in general, statins don’t reduce mortality but do improve left ventricular function and reduce heart failure hospitalizations.

The meta-analysis, published in the December 15th American Journal of Cardiology, involved 10,192 patients, with a weighted mean age of 69.2 years, who were treated with either 10 to 40 mg of rosuvastatin, 10 to 40 mg of atorvastatin, 5 to 10 mg of simvastatin, or placebo.

Dr. Michael J. Lipinski from University of Virginia Health System, Charlottesville and colleagues report that in the overall analysis, statin therapy significantly decreased hospitalization for worsening heart failure (odds ratio, 0.67) and increased left ventricular ejection fraction (LVEF) by 4.2% (p=0.004). Statins did not decrease the risks of all-cause mortality, cardiovascular mortality, or sudden cardiac mortality, however.

Post hoc analyses showed that the decrease in hospitalization for heart failure was especially notable with atorvastatin, and improvements in ejection fraction were only seen with atorvastatin or simvastatin.

Atorvastatin also produced a significant decrease in all-cause mortality (OR, 0.39; p=0.004) compared to placebo, the results show.

In contrast, rosuvastatin was not associated with reductions in hospitalization for worsening heart failure or mortality, or with improvements in systolic function.

Statins did not increase patients’ risk of serious adverse drug reactions or gastrointestinal, hepatic, or muscle-related adverse drug reactions.

“Our study suggests there is not a class effect for statins in heart failure and, therefore, patients with heart failure may potentially derive benefit from statins” other than rosuvastatin — such as atorvastatin or simvastatin, Dr. Lipinski told Reuters Health by email.

He and his colleagues point out that simvastatin and atorvastatin, but not rosuvastatin, are lipophilic, and “the greater uptake of lipophilic statins by the heart may help explain the benefit…on LVEF.”

“Our findings in this meta-analysis are hypothesis generating,” Dr. Lipinski said, adding, “We believe a large multi-center randomized placebo-controlled trial is necessary to evaluate the impact of other statins.”

Reference:
Am J Cardiol 2009;104:1708-1716.