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Insani WN, Whittlesea C, Ju C, Man KKC, Alwafi H, Alsharif A, Chapman S, Wei L. Statin-related adverse drug reactions in UK primary care consultations: A retrospective cohort study to evaluate the risk of cardiovascular events and all-cause mortality. Br J Clin Pharmacol 2022; 88:4902-4914. [PMID: 35695656 PMCID: PMC9796911 DOI: 10.1111/bcp.15438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/28/2022] [Accepted: 06/05/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS To investigate the risk of cardiovascular disease (CVD) events and all-cause mortality in patients with statin-related adverse drug reaction (ADR) consultation in primary care and examine whether different treatments following the ADR affect subsequent outcomes. METHODS This was a retrospective cohort study of statin users between 2004 and 2019 using IQVIA Medical Research Data (formally known as the THIN database). Patients with statin-related ADR consultation were matched by propensity score (1:1) to statin users without ADR consultation based on demographics, comorbidities and concomitant medication. Cox proportional hazard regression was used to compare the risk of subsequent CVD event and all-cause mortality, stratified by history of CVD. In the secondary analysis among patients with statin-related ADR, treatment changes within a 1-year period following the ADR were examined and the outcomes were compared between different treatment groups. RESULTS Among 1 564 687 statin users, 19 035 (1.22%) had a statin-related ADR consultation in primary care. The mean (standard deviation) follow-up time was 6.32 (3.74) years and 5.31 (3.83) years for CVD primary and secondary prevention cohorts, respectively. Statin-related ADR consultation was associated with subsequent CVD events in both cohorts (adjusted hazard ratio [HR] of 1.39 [95% CI 1.23, 1.57] and 1.34 [95% CI 1.25,1.42], respectively). In the secondary analysis among patients with statin-related ADR consultation, we found that (i) continued statin prescription or combination of any statin with additional lipid-lowering treatment (LLT) and (ii) other LLT only were associated with lower risks of CVD event (adjusted HR 0.71 [95% CI 0.64, 0.78] and 0.75 [95% CI 0.62, 0.92], respectively) and all-cause mortality (adjusted HR 0.46 [95% CI 0.42, 0.50] and 0.52 [95% CI, 0.43, 0.64], respectively), compared to discontinuation of all LLT. CONCLUSION Statin-related ADR was associated with an increased risk of subsequent CVD event, indicating that these patients should be monitored more closely. Continued lipid-lowering medication is of importance to protect against CVD events and mortality.
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Affiliation(s)
- Widya N. Insani
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacology and Clinical Pharmacy, Centre of Excellence for Pharmaceutical Care InnovationPadjadjaran UniversityBandungIndonesia
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK
| | - Chengsheng Ju
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and ResearchUniversity of Hong KongHong Kong Special Administrative RegionChina,Laboratory of Data Discovery for HealthHong Kong Science ParkHong Kong Special Administrative RegionChina
| | - Hassan Alwafi
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Faculty of MedicineUmm Al Qura UniversityMeccaSaudi Arabia
| | - Alaa Alsharif
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacy Practice, Faculty of PharmacyPrincess Nourah bint Abdulrahman UniversityRiyadhSaudi Arabia
| | - Sarah Chapman
- Department of Pharmacy and PharmacologyUniversity of BathBathUK
| | - Li Wei
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Laboratory of Data Discovery for HealthHong Kong Science ParkHong Kong Special Administrative RegionChina
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Climent E, Benaiges D, Pedro-Botet J. Hydrophilic or Lipophilic Statins? Front Cardiovasc Med 2021; 8:687585. [PMID: 34095267 PMCID: PMC8172607 DOI: 10.3389/fcvm.2021.687585] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Drugs can be classified as hydrophilic or lipophilic depending on their ability to dissolve in water or in lipid-containing media. The predominantly lipophilic statins (simvastatin, fluvastatin, pitavastatin, lovastatin and atorvastatin) can easily enter cells, whereas hydrophilic statins (rosuvastatin and pravastatin) present greater hepatoselectivity. Although the beneficial role of statins in primary and secondary cardiovascular prevention has been unequivocally confirmed, the possible superiority of one statin or other regarding their solubility profile is still not well-established. In this respect, although some previously published observational studies and clinical trials observed a superiority of lipophilic statins in cardiovascular outcomes, these results could also be explained by a greater low-density lipoprotein cholesterol reduction with this statin type. On the other hand, previous studies reported conflicting results as to the possible superiority of one statin type over the other regarding heart failure outcomes. Furthermore, adverse events with statin therapy may also be related to their solubility profile. Thus, the aim of the present review was to collect clinical evidence on possible differences in cardiovascular outcomes among statins when their solubility profile is considered, and how this may also be related to the occurrence of statin-related adverse effects.
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Affiliation(s)
- Elisenda Climent
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Techorueangwiwat C, Kanitsoraphan C, Hansrivijit P. Therapeutic implications of statins in heart failure with reduced ejection fraction and heart failure with preserved ejection fraction: a review of current literature. F1000Res 2021; 10:16. [PMID: 36873456 PMCID: PMC9982192 DOI: 10.12688/f1000research.28254.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/20/2022] Open
Abstract
Statins are one of the standard treatments to prevent cardiovascular events such as coronary artery disease and heart failure (HF). However, data on the use of statins to improve clinical outcomes in patients with established HF remains controversial. We summarized available clinical studies which investigated the effects of statins on clinical outcomes in patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Statins possess many pleiotropic effects in addition to lipid-lowering properties that positively affect the pathophysiology of HF. In HFrEF, data from two large randomized placebo-controlled trials did not show benefits of statins on mortality of patients with HFrEF. However, more recent prospective cohort studies and meta-analyses have shown decreased risk of mortality as well as cardiovascular hospitalization with statins treatment. In HFpEF, most prospective and retrospective cohort studies as well as meta analyses have consistently reported positive effects of statins, including reducing mortality and improving other clinical outcomes. Current evidence also suggests better outcomes with lipophilic statins in patients with HF. In summary, statins might be effective in improving survival and other clinical outcomes in patients with HF, especially for patients with HFpEF. Lipophilic statins might also be more beneficial for HF patients. Based on current evidence, statins did not cause harm and should be continued in HF patients who are already taking the medication. Further randomized controlled trials are needed to clarify the benefits of statins in HF patients.
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Napoli C, Benincasa G, Donatelli F, Ambrosio G. Precision medicine in distinct heart failure phenotypes: Focus on clinical epigenetics. Am Heart J 2020; 224:113-128. [PMID: 32361531 DOI: 10.1016/j.ahj.2020.03.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/07/2020] [Indexed: 12/31/2022]
Abstract
Heart failure (HF) management is challenging due to high clinical heterogeneity of this disease which makes patients responding differently to evidence-based standard therapy established by the current reductionist approach. Better understanding of the genetic and epigenetic interactions may clarify molecular signatures underlying maladaptive responses in HF, including metabolic shift, myocardial injury, fibrosis, and mitochondrial dysfunction. DNA methylation, histone modifications and micro-RNA (miRNAs) may be major epigenetic players in the pathogenesis of HF. DNA hypermethylation of the kruppel-like factor 15 (KLF15) gene plays a key role in switching the failing heart from oxidative to glycolytic metabolism. Moreover, hypomethylation at H3K9 promoter level of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) genes also leads to reactivation of fetal genes in man. The role of miRNAs has been investigated in HF patients undergoing heart transplantation, for whom miR-10a, miR-155, miR-31, and miR-92 may be putative useful prognostic biomarkers. Recently, higher RNA methylation levels have been observed in ischemic human hearts, opening the era of "epitranscriptome" in the pathogenesis of HF. Currently, hydralazine, statins, apabetalone, and omega-3 polyunsatured fatty acids (PUFA) are being tested in clinical trials to provide epigenetic-driven therapeutic interventions. Moreover, network-oriented analysis could advance current medical practice by focusing on protein-protein interactions (PPIs) perturbing the "cardiac" interactome. In this review, we provide an epigenetic map of maladaptive responses in HF patients. Furthermore, we propose the "EPi-transgeneratIonal network mOdeling for STratificatiOn of heaRt Morbidity" (EPIKO-STORM), a clinical research strategy offering novel opportunities to stratify the natural history of HF.
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Giurgea GA, Karkutli E, Granegger S, Berent R, Derfler K, Sinzinger H. One year follow-up of patients with reduced left ventricular ejection fraction (LVEF) on lipoprotein apheresis. ATHEROSCLEROSIS SUPP 2019; 40:44-48. [PMID: 31818449 DOI: 10.1016/j.atherosclerosissup.2019.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is a valuable measure to assess left ventricular systolic function. Lipid lowering therapy by statins has been shown to have an impact on LVEF already after a 6 months treatment. Higher doses of statins have been claimed to be more effective as compared to a conventional one and even a difference between lipophilic and hydrophilic compounds has been reported. The effect of regular lipoprotein-apheresis (LP-apheresis) on LVEF was previously poorly examined. Patients involved in a regular LP-apheresis program are supposed to undergo a number of follow-up investigations among them myocardial scintigraphy and LVEF, measured by radionuclide ventriculography. METHODS We examined 18 patients before initiation and after one year of ongoing LP-apheresis. 13 patients (11 males, 2 females, mean age 58.3 ± 5.3 years, groups A) were since more than a year on stable, unchanged statin treatment (atorvastatin 40 mg, simvastatin 40 mg, rosuvastatin 20 mg±ezetimibe), the other 5 patients (3 males, 2 females, mean age 57.1 ± 4.6 years, group B) were intolerant to statins being on micronized fenofibrate±resorption inhibitors (cholestyramine). All patients had a Lp(a) < 30 mg/dl. As part of the usual follow-up monitoring, LVEF was determined by means of radionuclide ventriculography after application of 550 MBq 99m Tc-pertechnetate. RESULTS The follow-up LVEF was checked at a mean of 48.7 weeks in group A and 51.2 weeks in group B. Except in 1 patient (LVEF 46.8% before vs. 45.2% after LP-apheresis initiation) in group A we noted a significant increase in LVEF in 12 patients of group A (92%) and in all patients of group B. Mean LVEF increased significantly in both groups (A: 42.7±8.1 → 46.5±7.5% (p < 0.001) and B: 41.9±8.4 → 46.5±6.3 %; p < 0.001). The relative rise was nearly identical (group A 9.6%, in group B 9.7%). CONCLUSIONS Our findings indicate that regular long-term LP-apheresis treatment apparently increases LVEF, independently on current statin treatment. This implies a role of lowering of atherogenic lipoproteins as underlying mechanism. A prospective study should clarify the relative extent of LVEF improvement induced by LP-apheresis.
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Affiliation(s)
| | - Elodie Karkutli
- Institute for Diagnosis and Treatment of Lipid Disorders and Atherosclerosis (ATHOS), Austria
| | - Susanne Granegger
- Institute for Diagnosis and Treatment of Lipid Disorders and Atherosclerosis (ATHOS), Austria
| | - Robert Berent
- HerzReha Bad Ischl, Center for Cardiovascular Rehabilitation, Bad Ischl, Austria
| | - Kurt Derfler
- Institute for Diagnosis and Treatment of Lipid Disorders and Atherosclerosis (ATHOS), Austria
| | - Helmut Sinzinger
- Institute for Diagnosis and Treatment of Lipid Disorders and Atherosclerosis (ATHOS), Austria; Department of Lipid Metabolism, Faculty of Medicine, Sigmund Freud University, Vienna, Austria; Isotopix, Institute for Nuclear Medicine, Vienna, Austria.
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Bielecka-Dabrowa A, Bytyçi I, Von Haehling S, Anker S, Jozwiak J, Rysz J, Hernandez AV, Bajraktari G, Mikhailidis DP, Banach M. Association of statin use and clinical outcomes in heart failure patients: a systematic review and meta-analysis. Lipids Health Dis 2019; 18:188. [PMID: 31672151 PMCID: PMC6822388 DOI: 10.1186/s12944-019-1135-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins' prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF. METHODS We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization. RESULTS Finally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72-0.83, P < 0.0001, I2 = 63%), CV mortality (HR 0.82, 95% CI: 0.76-0.88, P < 0.0001, I2 = 63%), and CV hospitalization (HR 0.78, 95% CI: 0.69-0.89, P = 0.0003, I2 = 36%). All-cause mortality was reduced on statin therapy in HF with both EF < 40% and ≥ 40% (HR: 0.77, 95% Cl: 0.68-0.86, P < 0.00001, and HR 0.75, 95% CI: 0.69-0.82, P < 0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79-0.93, P = 0.0003, and HR 0.83, 95% CI: 0.77-0.90, P < 0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64-0.99, P = 0.04 and HR 0.76 95% CI: 0.61-0.93, P = 0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies' analyses; the effect was also larger and significant for lipophilic than hydrophilic statins. CONCLUSIONS In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Hypertension, Medical University of Lodz, Rzgowska, 281/289; 93-338, Łódź, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephan Von Haehling
- Department of Cardiology and Pneumology, University Medical Center Gottingen (UMG), Gottingen, Germany
| | - Stefan Anker
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jacek Jozwiak
- Department of Family Medicine and Public Health, Institute of Medicine, University of Opole, Opole, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
- School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Rzgowska, 281/289; 93-338, Łódź, Poland.
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.
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Zvizdić F, Godinjak A, Durak-Nalbantic A, Rama A, Iglica A, Vucijak-Grgurevic M, Sokolovic S. Impact of Different Types of Statins on Clinical Outcomes in Patients Hospitalized for Ischemic Heart Failure. Med Arch 2019; 72:401-405. [PMID: 30814769 PMCID: PMC6340614 DOI: 10.5455/medarh.2018.72.401-405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: The effect of statins on risk of heart failure (HF) hospitalization and lethal outcome remains dubious. Aim: To investigate whether statin therapy improves clinical outcomes in patients hospitalized for ischemic heart failure (HF), to compare the efficacy of lipophilic and hydrophilic statins and to investigate which statin subtype provides better survival and other outcome benefits. Material and Methods: Total amount of 155 patients in the study were admitted to the Clinic for Cardiology, Rheumatology and Vascular diseases in Clinical Center University of Sarajevo in the period from January 2014- December 2017. Inclusion criteria was HF caused by ischemic coronary artery disease upon admission. For each patient the following data were obtained: gender, age, comorbidities and medications on discharge. New York Heart Association (NYHA) class for heart failure was determined by physician evaluation and left ventricle ejection fraction (LVEF) was determined by echocardiography. The patients were followed for a period of two years. Outcome points were: rehospitalization, in-hospital death, mortality after 6 months, 1 year and 2 years. All-cause mortality included cardiovascular events or worsening heart failure. Results: Overall, 58.9% of HF patients received statin therapy, with 33.9% patients receiving atorvastatin and 25.0% rosuvastatin therapy. The most frequent rehospitalization was in patients without statin therapy (66.7%), followed by patients on rosuvastatin (64.1%), and atorvastatin (13.2%), with statistically significant difference p = 0.001 between the groups. Mortality after 6 months, 1 year and 2 years was the most frequent in patients without statin therapy with a statistically significant difference (p = 0.001). Progression of HF accounted for 31.7% of mortality in patients without statin therapy, 12.8% in patients on rosuvastatin therapy and 3.8% in patients on atorvastatin therapy (p = 0.004). Conclusion: Lipophilic statin therapy is associated with substantially better long-term outcomes in patients with HF.
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Affiliation(s)
- Faris Zvizdić
- Department for Cardiology, Clinic for Heart, Vascular Diseases and Rheumatology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amina Godinjak
- Department for Emergency Medicine, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Durak-Nalbantic
- Department for Cardiology, Clinic for Heart, Vascular Diseases and Rheumatology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Admir Rama
- Bahceci IVF Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amer Iglica
- Department for Cardiology, Clinic for Heart, Vascular Diseases and Rheumatology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Marina Vucijak-Grgurevic
- Department for Cardiology, Clinic for Heart, Vascular Diseases and Rheumatology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sekib Sokolovic
- Department for Cardiology, Clinic for Heart, Vascular Diseases and Rheumatology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Samolyuk MO, Grigorieva NY. [Evaluation of endothelial dysfunction and the possibility of its correction at the present stage in patients with cardiovascular diseases]. ACTA ACUST UNITED AC 2019; 59:4-9. [PMID: 30990146 DOI: 10.18087/cardio.2524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 11/18/2022]
Abstract
The review describes the current understanding of endothelial dysfunction, methods of its evaluation, and highlights the advantages and disadvantages of various techniques. The role of nitric oxide and endothelin as important markers of endothelial dysfunction is shown, and the methods of their determination in clinical practice are described. The authors conclude that in order to improve the life expectancy and quality of life of patients with cardiovascular diseases, reduce the risk and frequency of complications and mortality rates, it is necessary to study the function of endothelium in more detail and to look for ways of drug correction, taking into account the pathogenetic mechanisms of its formation.
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Affiliation(s)
- M O Samolyuk
- Privolzhsky Research Medical University, Minin and Pozharsky square 10/1, Nizhny Novgorod 603950
| | - N Yu Grigorieva
- Privolzhsky Research Medical University, Minin and Pozharsky square 10/1, Nizhny Novgorod 603950
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Al-Gobari M, Al-Aqeel S, Gueyffier F, Burnand B. Effectiveness of drug interventions to prevent sudden cardiac death in patients with heart failure and reduced ejection fraction: an overview of systematic reviews. BMJ Open 2018; 8:e021108. [PMID: 30056380 PMCID: PMC6067373 DOI: 10.1136/bmjopen-2017-021108] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To summarise and synthesise the current evidence regarding the effectiveness of drug interventions to prevent sudden cardiac death (SCD) and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). DESIGN Overview of systematic reviews. DATA SOURCES MEDLINE, Embase, ISI Web of Science and Cochrane Library from inception to May 2017; manual search of references of included studies for potentially relevant reviews. ELIGIBILITY CRITERIA FOR STUDY SELECTION We reviewed the effectiveness of drug interventions for SCD and all-cause mortality prevention in patients with HFrEF. We included overviews, systematic reviews and meta-analyses of randomised controlled trials of beta-blockers, angiotensin-converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARBs), antialdosterones or mineralocorticoid-receptor antagonists, amiodarone, other antiarrhythmic drugs, combined ARB/neprilysin inhibitors, statins and fish oil supplementation. REVIEW METHODS Two independent reviewers extracted data and assessed the methodological quality of the reviews and the quality of evidence for the primary studies for each drug intervention, using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) and Grading of Recommendations, Assessment, Development and Evaluation(GRADE), respectively. RESULTS We identified 41 reviews. Beta-blockers, antialdosterones and combined ARB/neprilysin inhibitors appeared effective to prevent SCD and all-cause mortality. ACE-i significantly reduced all-cause mortality but not SCD events. ARBs and statins were ineffective where antiarrhythmic drugs and omega-3 fatty acids had unclear evidence of effectiveness for prevention of SCD and all-cause mortality. CONCLUSIONS This comprehensive overview of systematic reviews confirms that beta-blockers, antialdosterone agents and combined ARB/neprilysin inhibitors are effective on SCD prevention but not ACE-i or ARBs. In patients with high risk of SCD, an alternative therapeutic strategy should be explored in future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017: CRD42017067442.
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Affiliation(s)
- Muaamar Al-Gobari
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sinaa Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - François Gueyffier
- Laboratoire de Biologie et Biométrie Evolutive-Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Bielecka-Dabrowa A, Fabis J, Mikhailidis DP, von Haehling S, Sahebkar A, Rysz J, Banach M. Prosarcopenic Effects of Statins May Limit Their Effectiveness in Patients with Heart Failure. Trends Pharmacol Sci 2018; 39:331-353. [DOI: 10.1016/j.tips.2018.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/25/2022]
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Katsiki N, Kolovou G, Perez-Martinez P, Mikhailidis DP. Dyslipidaemia in the elderly: to treat or not to treat? Expert Rev Clin Pharmacol 2018; 11:259-278. [PMID: 29303009 DOI: 10.1080/17512433.2018.1425138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The elderly population (i.e. aged ≥ 65 years) is increasing worldwide. Ageing is associated with a higher incidence and prevalence of cardiovascular disease (CVD). Areas covered: The prevalence of CVD risk factors including type 2 diabetes mellitus, hypertension and dyslipidaemia also increases with advancing age, contributing to the higher absolute CVD risk observed in the elderly. The present narrative review comments on the associations of dyslipidaemia with CVD as well as the effects of lifestyle measures and lipid-lowering drugs on lipids and CVD risk with a special focus on the elderly population. Individual treatment goals and therapeutic options according to current guidelines are also reviewed. Finally, we discuss special characteristics of the elderly that may influence the efficacy and safety of drug therapy and should be considered before selection of hypolipidaemic pharmacotherapy. Expert commentary: There may be a greater CVD benefit in older patients following drug therapy compared with younger ones. Treatment goals and therapeutic options should be individualized according to current guidelines. Specific characteristics that may influence the efficacy and safety of drug therapy in the elderly should be considered in relation to dyslipidaemia treatment.
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Affiliation(s)
- Niki Katsiki
- a Second Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, Hippocration Hospital , Thessaloniki , Greece
| | - Genovefa Kolovou
- b Cardiology Department and LDL-Apheresis Unit , Onassis Cardiac Surgery Center , Athens , Greece
| | - Pablo Perez-Martinez
- c Lipid and Atherosclerosis Unit , IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III , Spain
| | - Dimitri P Mikhailidis
- d Department of Clinical Biochemistry , Royal Free Hospital Campus, University College London Medical School, University College London (UCL) , London , UK
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Fröhlich H, Raman N, Täger T, Schellberg D, Goode KM, Kazmi S, Grundtvig M, Hole T, Cleland JGF, Katus HA, Agewall S, Clark AL, Atar D, Frankenstein L. Statins attenuate but do not eliminate the reverse epidemiology of total serum cholesterol in patients with non-ischemic chronic heart failure. Int J Cardiol 2017; 238:97-104. [PMID: 28342630 DOI: 10.1016/j.ijcard.2017.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND In patients with chronic heart failure (CHF) increasing levels of total serum cholesterol are associated with improved survival - while statin usage is not. The impact of statin treatment on the "reverse epidemiology" of cholesterol is unclear. METHODS 2992 consecutive patients with non-ischemic CHF due to left ventricular systolic dysfunction from the Norwegian CHF Registry and the CHF Registries of the Universities of Hull, UK, and Heidelberg, Germany, were studied. 1736 patients were individually double-matched on both cholesterol levels and the individual propensity scores for statin treatment. All-cause mortality was analyzed as a function of baseline cholesterol and statin use in both the general and the matched sample. RESULTS 1209 patients (40.4%) received a statin. During a follow-up of 13,740 patient-years, 360 statin users (29.8%) and 573 (32.1%) statin non-users died. When grouped according to total cholesterol levels as low (≤3.6mmol/L), moderate (3.7-4.9mmol/L), high (4.8-6.2mmol/L), and very high (>6.2mmol/L), we found improved survival with very high as compared with low cholesterol levels. This association was present in statin users and non-users in both the general and matched sample (p<0.05 for each group comparison). The negative association of total cholesterol and mortality persisted when cholesterol was treated as a continuous variable (HR 0.83, 95%CI 0.77-0.90, p<0.001 for matched patients), but it was less pronounced in statin users than in non-users (F-test p<0.001). CONCLUSIONS Statins attenuate but do not eliminate the reverse epidemiological association between increasing total serum cholesterol and improved survival in patients with non-ischemic CHF.
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Affiliation(s)
- Hanna Fröhlich
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Nandita Raman
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Tobias Täger
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Dieter Schellberg
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Kevin M Goode
- Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom
| | - Syed Kazmi
- Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom
| | - Morten Grundtvig
- Medical Department, Innlandet Hospital Trust Division Lillehammer, Anders Sandvigs gate 17, 2609 Lillehammer, Norway
| | - Torstein Hole
- Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway & Medical Clinic, Helse Møre and Romsdal CHF, Åsehaugen 1, 6017 Ålesund, Norway
| | - John G F Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, SW72AZ London, United Kingdom
| | - Hugo A Katus
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Andrew L Clark
- Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Lutz Frankenstein
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany.
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Bonsu KO, Reidpath DD, Kadirvelu A. Lipophilic Statin Versus Rosuvastatin (Hydrophilic) Treatment for Heart Failure: a Meta-Analysis and Adjusted Indirect Comparison of Randomised Trials. Cardiovasc Drugs Ther 2017; 30:177-88. [PMID: 26780905 DOI: 10.1007/s10557-015-6636-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study aims to compare lipophilic and hydrophilic statin therapy on clinical outcomes of heart failure (HF) using a systematic review and an adjusted indirect comparison meta-analysis. Outcomes were all-cause mortality, cardiovascular mortality, cardiovascular hospitalization and hospitalization for worsening HF. METHODS We conducted a search of PubMed, EMBASE and Cochrane databases until 31st December 2014 for randomized control trials (RCTs) in HF evaluating statins versus placebo. Identified RCTs and their respective abstracted information were grouped according to statin type evaluated and analyzed separately. Outcomes were initially pooled with the Peto's one-step method, producing odd ratios (OR) and 95 % confidence intervals (CI) for each statin type. Using these pooled estimates, we performed adjusted indirect comparisons of lipophilic versus hydrophilic statin for each outcome. RESULTS Thirteen studies involving 10,966 patients were identified and analyzed. Lipophilic statins were superior to hydrophilic rosuvastatin regarding all-cause mortality (OR 0 · 50; 95 % CI, 0 · 11-0 · 89; p = 0 · 01), cardiovascular mortality (OR 0 · 61; 0 · 25-0 · 97; p = 0 · 009), and hospitalization for worsening HF (OR 0 · 52; 0 · 21-0 · 83; p = 0 · 0005). However, both statins were comparable with regards to cardiovascular hospitalization [OR 0 · 80 (0 · 31, 1 · 28); p = 0 · 36]. CONCLUSIONS Lipophilic statin treatment shows significant decreases in all-cause mortality, cardiovascular mortality and hospitalization for worsening HF compared with rosuvastatin treatment. This meta-analysis provides preliminary evidence that lipophilic statins offer better clinical outcomes in HF till data from head to head comparisons are available.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Medicine and Health Sciences, Monash University, Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, 46150, Selangor DE, Malaysia. .,Pharmacy Department, Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana.
| | - Daniel Diamond Reidpath
- School of Medicine and Health Sciences, Monash University, Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, 46150, Selangor DE, Malaysia
| | - Amudha Kadirvelu
- School of Medicine and Health Sciences, Monash University, Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, 46150, Selangor DE, Malaysia
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Al-Gobari M, Le HH, Fall M, Gueyffier F, Burnand B. No benefits of statins for sudden cardiac death prevention in patients with heart failure and reduced ejection fraction: A meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0171168. [PMID: 28166237 PMCID: PMC5293250 DOI: 10.1371/journal.pone.0171168] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Statins showed mixed results in heart failure (HF) patients. The benefits in major HF outcomes, including all-cause mortality and sudden cardiac death (SCD), have always been discordant across systematic reviews and meta-analyses. We intended to systematically identify and appraise the available evidence that evaluated the effectiveness of statins in clinical outcomes for HF patients. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched, until April 28, 2016: Medline, Embase, ISI Web of Science and EBM reviews (Cochrane DSR, ACP journal club, DARE, CCTR, CMR, HTA, and NHSEED), checked clinicaltrials.gov for ongoing trials and manually searched references of included studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We identified 24 randomized clinical trials that evaluated the efficacy of statins for HF patients. All randomized clinical trials were assessed for risk of bias and pooled together in a meta-analysis. Pre-specified outcomes were sudden cardiac death, all-cause mortality, and hospitalization for worsening heart failure. RESULTS Statins did not reduce sudden cardiac death (SCD) events in HF patients [relative risk (RR) 0.92, 95% confidence interval (CI) 0.70 to 1.21], all-cause mortality [RR 0.88, 95% CI 0.75 to 1.02] but significantly reduced hospitalization for worsening heart failure (HWHF) although modestly [RR 0.79, 95% CI 0.66 to 0.94]. Nevertheless, estimated predictive intervals were insignificant in SCD, all-cause mortality and HWHF [RR, 0.54 to 1.63, 0.64 to 1.19, and 0.54 to 1.15], respectively. An important finding was the possible presence of publication bias, small-study effects and heterogeneity of the trials conducted in HF patients. CONCLUSIONS Statins do not reduce sudden cardiac death, all-cause mortality, but may slightly decrease hospitalization for worsening heart failure in HF patients. The evaluation of the risk of biases suggested moderate quality of the published results. Until new evidence is available, this study supports the 2013 ACCF/AHA guidelines to not systematically prescribe statins in "only" HF patients, which should help avoid unnecessary polypharmacy.
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Affiliation(s)
- Muaamar Al-Gobari
- Institute of social & preventive medicine (IUMSP) and Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- * E-mail:
| | - Hai-Ha Le
- Laboratoire de Biologie et Biométrie Evolutive–Service de pharmacologie clinique, Equipe Modélisation des Effets Thérapeutiques (EMET), UMR, Université Claude Bernard Lyon1, Lyon, France
| | - Mor Fall
- Laboratoire de Biologie et Biométrie Evolutive–Service de pharmacologie clinique, Equipe Modélisation des Effets Thérapeutiques (EMET), UMR, Université Claude Bernard Lyon1, Lyon, France
- Laboratoire de Pharmacologie & de Pharmacodynamie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - François Gueyffier
- Laboratoire de Biologie et Biométrie Evolutive–Service de pharmacologie clinique, Equipe Modélisation des Effets Thérapeutiques (EMET), UMR, Université Claude Bernard Lyon1, Lyon, France
| | - Bernard Burnand
- Institute of social & preventive medicine (IUMSP) and Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Fukuta H, Goto T, Wakami K, Ohte N. The effect of statins on mortality in heart failure with preserved ejection fraction: a meta-analysis of propensity score analyses. Int J Cardiol 2016; 214:301-6. [DOI: 10.1016/j.ijcard.2016.03.186] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
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Westman PC, Lipinski MJ. The use of statins in patients with heart failure: more questions than answers. J Thorac Dis 2015; 7:1687-90. [PMID: 26623083 DOI: 10.3978/j.issn.2072-1439.2015.10.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The use of statins to treat patients with heart failure (HF) is controversial due to conflicting results from large, prospective, randomized, placebo-controlled trials and other smaller studies. A recent comprehensive, well-conducted meta-analysis from Preiss and colleagues sought to determine whether statin therapy had an effect on major HF outcomes such as hospitalization and death. Although the study demonstrated a significant effect of statin therapy on HF hospitalizations, several limitations involving the participant data and nature of statin used in the analyzed trials raise questions about the inferences that can be drawn from the study results.
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Affiliation(s)
- Peter C Westman
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC, USA
| | - Michael J Lipinski
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC, USA
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Sahebkar A, Ponziani MC, Goitre I, Bo S. Does statin therapy reduce plasma VEGF levels in humans? A systematic review and meta-analysis of randomized controlled trials. Metabolism 2015; 64:1466-76. [PMID: 26347012 DOI: 10.1016/j.metabol.2015.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/06/2015] [Accepted: 08/07/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effect of statins on plasma concentrations of vascular endothelial growth factor (VEGF), the main angiogenic growth factor with pro-inflammatory and atherogenic properties, is controversial. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to obtain a conclusive result in humans. METHODS PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched to identify RCTs investigating the impact of statins on plasma VEGF concentrations. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Meta-regression, sensitivity analysis and publication bias assessments were performed using standard methods. RESULTS Eight RCTs examining the effects of statins on plasma VEGF concentrations were included. Meta-analysis suggested a significant reduction of plasma VEGF levels following statin therapy (weighed mean difference: -19.88 pg/mL, 95% CI: -35.87, -3.89, p=0.015). VEGF reductions were observed in the subsets of trials with treatment durations ≥4 weeks (-19.54, -37.78, -1.30, p=0.036), LDL-C reductions ≥50 mg/dL (-28.59, -43.68, -13.50, p<0.001), lipophilic statins (-22.31, -40.65, -3.98, p=0.017), and diseased populations (-21.08, -39.97, -2.18, p=0.029), but not in the opposite subsets. Meta-regression also suggested a significant association between changes in plasma VEGF levels and LDL-C changes, treatment duration, but not molar dose of statins. CONCLUSIONS These results suggest a significant reduction in plasma VEGF concentrations following statin therapy. This effect depends on duration of treatment, LDL-lowering activity, lipophilicity of statins, and health status of studied individuals. Further RCTs are needed to explore if the VEGF reduction is implicated in the statin benefits on cardiovascular outcomes.
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Affiliation(s)
- Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Maria Chantal Ponziani
- Division of Endocrinology and Metabolic Diseases, Hospital of Novara-University of Piemonte Orientale, Novara, Italy
| | - Ilaria Goitre
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, Turin, Italy.
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Statin therapy reduces plasma endothelin-1 concentrations: A meta-analysis of 15 randomized controlled trials. Atherosclerosis 2015; 241:433-42. [DOI: 10.1016/j.atherosclerosis.2015.05.022] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/26/2015] [Accepted: 05/19/2015] [Indexed: 12/18/2022]
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Ayer A, Macdonald P, Stocker R. CoQ10Function and Role in Heart Failure and Ischemic Heart Disease. Annu Rev Nutr 2015; 35:175-213. [DOI: 10.1146/annurev-nutr-071714-034258] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Peter Macdonald
- Cardiac Physiology and Transplantation Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia;
| | - Roland Stocker
- Vascular Biology and
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia
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Alehagen U, Benson L, Edner M, Dahlström U, Lund LH. Association between use of statins and outcomes in heart failure with reduced ejection fraction: prospective propensity score matched cohort study of 21 864 patients in the Swedish Heart Failure Registry. Circ Heart Fail 2015; 8:252-60. [PMID: 25575580 DOI: 10.1161/circheartfailure.114.001730] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In heart failure (HF) with reduced ejection fraction, randomized trials of statins did not demonstrate improved outcomes. However, randomized trials may not always be generalizable. The aim was to determine whether statins are associated with improved outcomes in an unselected nationwide population of patients with HF with reduced ejection fraction overall and in relation to ischemic heart disease (IHD). METHODS AND RESULTS In the Swedish Heart Failure Registry, 21 864 patients with HF with reduced ejection fraction (age ± SD, 72±12 years; 29% women), of whom 10 345 (47%) were treated with statins, were studied. Propensity scores for statin use were derived from 42 baseline variables. The associations between statin use and outcomes were assessed with Cox regressions in a population matched 1:1 based on propensity score and age and in the overall population with adjustment for propensity score and age. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality; HF hospitalization; and combined all-cause mortality or cardiovascular hospitalization. Survival at 1 year in the matched population was 83% for statin-treated versus 79% for untreated patients (hazard ratio, 0.81; 95% confidence interval, 0.76-0.86; P<0.001). In the unmatched population, 1-year survival was 85% for statin-treated versus 79% for untreated patients, hazard ratio after adjustment for propensity score and age was 0.84 (95% confidence interval, 0.80-0.89; P<0.001). No examined baseline variables interacted with statin use except for IHD (P=0.001), with a hazard ratio of 0.76 (95% confidence interval, 0.70-0.82, P<0.001) with IHD and 0.95 (95% confidence interval, 0.85-1.07; P=0.430 without IHD. Statin use was also associated with reduced risk for all 3 secondary outcomes. CONCLUSIONS In an unselected nationwide population of patients with HF with reduced ejection fraction, statins were associated with improved outcomes, specifically in the presence of IHD. This contrasts with previous randomized controlled trials. Additional randomized controlled trials with more generalized inclusion or focused on IHD may be warranted.
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Affiliation(s)
- Urban Alehagen
- From the Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Departments of Clinical Science and Education (L.B.) and Medicine (M.E., L.L.), Karolinska Institutet, Stockholm, Sweden; and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (M.E., L.L.).
| | - Lina Benson
- From the Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Departments of Clinical Science and Education (L.B.) and Medicine (M.E., L.L.), Karolinska Institutet, Stockholm, Sweden; and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (M.E., L.L.)
| | - Magnus Edner
- From the Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Departments of Clinical Science and Education (L.B.) and Medicine (M.E., L.L.), Karolinska Institutet, Stockholm, Sweden; and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (M.E., L.L.)
| | - Ulf Dahlström
- From the Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Departments of Clinical Science and Education (L.B.) and Medicine (M.E., L.L.), Karolinska Institutet, Stockholm, Sweden; and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (M.E., L.L.)
| | - Lars H Lund
- From the Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Departments of Clinical Science and Education (L.B.) and Medicine (M.E., L.L.), Karolinska Institutet, Stockholm, Sweden; and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (M.E., L.L.)
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Sindone A. Statins in Heart Failure. Heart Lung Circ 2014; 23:895-6. [DOI: 10.1016/j.hlc.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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