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Statins may worsen symptoms in patients with diastolic heart failure

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Statin therapy may lead to worsening of dyspnea and fatigue in patients with diastolic heart failure (DHF), according to findings presented Tuesday at the American College of Chest Physicians’ CHEST 2009 meeting in San Diego, California.

Relative to DHF patients not treated with a statin, treated patients showed decreased exercise tolerance, “poorer indices of ventilation, and greater peak pulmonary artery pressure,” lead researcher Dr. Lawrence P. Cahalin, from Northeastern University, Boston, told Reuters Health.

By contrast, “patients with systolic heart failure (SHF) who were on a statin often had similar or better pulmonary function and exercise test results than patients with SHF not a statin,” he noted.

The study was a retrospective analysis of demographic, statin, pulmonary function (FEV1 and FVC), and exercise tolerance data in 139 patients with heart failure. Sixty-one were statin users (72% with DHF) and 75 were not (82% with DHF). Atorvastatin was the most commonly prescribed statin, used by 75% of patients.

On the overall analysis, statin users had significantly lower pulmonary function and exercise tolerance than did non-users (p < 0.05). Further analysis showed, however, that this was due to the greater representation of DHF patients in the group. In DHF patients, statin use was tied to a 12% decrease in pulmonary function measures (p < 0.05). As for exercise tolerance, peak Watts and peak VO2 were 16% and 18% lower, respectively, in DHF statin users than in non-users. In SHF patients, by contrast, there was a trend toward higher pulmonary function measures (11% to 14) with statin use. Moreover, in SHF patients, statin use did not impair measures of exercise tolerance. The take-home message, Dr. Cahalin said, is that “dyspnea and fatigue may worsen when patients with DHF are prescribed a statin, while those with SHF may have less dyspnea and fatigue when prescribed a statin. Also, the anti-inflammatory effect of statins appears to be most beneficial to patients with SHF -- perhaps because inflammation appears to be a more substantial component of SHF, while the role of inflammation in DHF is poorly understood.”