Initiating statin therapy in patients with heart failure with preserved ejection fraction (HFpEF) is associated with lower rates of all-cause mortality, major adverse cardiovascular events (MACE) and heart failure hospitalizations, according to new research published in JACC: Advances.[1]
Statins are highly effective cholesterol-lowering medications used for the prevention of atherosclerotic cardiovascular disease (ASCVD) and are recommended for both primary and secondary prevention of ASCVD,” wrote first author Ariela R. Orkaby, MD, a researcher with both Brigham and Women’s Hospital and the New England Geriatric Research, Education and Clinical Center, and colleagues. “However, the benefits of statins in individuals with heart failure are uncertain and remain an area of ongoing debate.”
While some recent studies have examined initiating statin therapy in patients with heart failure with reduced ejection fraction (HFrEF), less research is available on the topic of using them to treat patients who present with HFpEF, but no signs of ASCVD.
Orkaby et al. examined data from nearly 8,000 U.S. veterans who received a new diagnosis of HFpEF from 2002 to 2012. All participants had never been treated with statin therapy prior to their diagnosis, and they were all free of ASCVD. The average was 69 years old, 96% of participants were men and the mean ejection fraction was 60%.
Forty-seven percent of participants initiative statin therapy after their diagnosis. The most commonly prescribed statins were simvastatin (76%), lovastatin (9%), atorvastatin (7%) and pravastatin (6%), and other options were prescribed to less than 1% of patients.
Overall, after a mean follow-up of six years, patients who initiated statin therapy were less likely to die from any cause or experience a MACE, which was defined as a fatal or nonfatal myocardial infarction, a fatal or nonfatal stroke or revascularization. Hospitalizations for any reason and hospitalizations specifically for heart failure symptoms were also less likely among patients who started taking statins at the beginning of the analysis.
“This has important implications on a two-decade search for a therapy to improve survival in HFpEF. In particular, it strengthens the foundation for a potential randomized controlled trial to examine the effect of statins in HFpEF,” the authors wrote.
The researchers did highlight certain limitations that must be taken into consideration. For example, because all participants were U.S. veterans and nearly all of them were male, these results may not reflect how statins impact a more diverse patient population. Also, the authors noted that there is a potential for reverse causation, though they did take work to keep that risk to a minimum.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.