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Monayer A, Minha S, Maymon SL, Pereg D, Kalmanovich E, Moravsky G, Grupper A, Marcus G. Statin therapy impact on Long-Term outcomes in acute heart Failure: Retrospective analysis of hospitalized patients. IJC HEART & VASCULATURE 2024; 53:101431. [PMID: 38826832 PMCID: PMC11137506 DOI: 10.1016/j.ijcha.2024.101431] [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: 04/12/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/04/2024]
Abstract
Background Statin therapy is well-established for treating hyperlipidemia and ischemic heart disease (IHD), but its role in Acute Decompensated Heart Failure (ADHF) remains less clear. Despite varying clinical guidelines, the actual utilization and impact of statin therapy initiation in patients with ADHF with an independent indication for statin therapy have not been thoroughly explored. Methods We conducted a retrospective observational study on 5978 patients admitted with ADHF between January 1st, 2007, and December 31st, 2017. Patients were grouped based on their statin therapy status at admission and discharge. We performed multivariable analyses to identify independent predictors of short-term, intermediate-term, and long-term mortality. A sensitivity analysis was also conducted on patients with an independent indication for statin therapy but who were not on statins at admission. Results Of the total patient cohort, 73.9% had an indication for statin therapy. However, only 38.2% were treated with statins at admission, and 56.1% were discharged with a statin prescription. Patients discharged with statins were younger, predominantly male, and had a higher prevalence of IHD and other comorbidities. Statin therapy at discharge was an independent negative predictor of 5-year all-cause mortality (hazard ratio 0.80, 95% confidence interval 0.76-0.85). The sensitivity analysis confirmed these findings, demonstrating higher mortality rates in patients not initiated on statins during admission. Conclusions The study highlights significant underutilization of statin therapy among patients admitted with ADHF, even when there's an independent indication for such treatment. Importantly, initiation of statin therapy during hospital admission was independently associated with improved long-term survival.
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Affiliation(s)
- Antoinette Monayer
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Sa’ar Minha
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Shiri L. Maymon
- Department of Otolaryngology, Tel-Aviv Sourasky Medical Center, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - David Pereg
- Department of Cardiology, Meir Medical Center, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Eran Kalmanovich
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Gil Moravsky
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Avishay Grupper
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Gil Marcus
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
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Gouveia R, Madureira S, Elias C, Neves A, Soares PR, Soares-Carreira M, Pereira J, Ribeiro A, Amorim M, Almeida J, Araújo J, Lourenco P. Lower low density lipoprotein cholesterol associates to higher mortality in non-diabetic heart failure patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 18:200197. [PMID: 37521244 PMCID: PMC10374454 DOI: 10.1016/j.ijcrp.2023.200197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Background In patients with established heart failure (HF) low total cholesterol levels associate with worse prognosis. Evidence concerning the impact of Low-density lipoprotein cholesterol (LDL-c) in HF is scarce. We aimed to evaluate the prognostic impact of LDL-c in patients with HF, both with and without diabetes mellitus (DM). Methods We retrospectively analyzed outpatients with chronic HF with systolic dysfunction followed in our HF clinic from January/2012 to May/2018. LDL-c was calculated using the Friedewald's formula. Patients without a complete lipid profile were excluded. The endpoint under analysis was all-cause mortality. Patients were followed until January/2021. A Cox-regression analysis was used to study the prognostic impact of LDL-c. The LDL-c cut-off used was 100 mg/dL (mean value). Analysis was stratified according to the coexistence of DM. Multivariate models were built adjusting for age, sex, coronary artery disease, atherosclerotic non-coronary artery disease, arterial hypertension, smoking status, statin use, severity of systolic dysfunction, creatinine clearance and evidence-based therapy. Results We studied 522 chronic HF patients, mean age was 70 years, 66.5% males. Severe systolic dysfunction was present in 42.7%, 30.5% had coronary heart disease, 60.5% had arterial hypertension, 41.6% had DM. A total of 92.0% were treated with beta blocker, 87.5% with an ACEi/ARB and 29.1% with a MRA. During a median follow-up of 53 (interquartile range 33-73) months, 235 (45%) patients died. Patients with LDL-c ≤100 mg/dL presented increased multivariate-adjusted risk of all-cause mortality: HR = 1.58 (95% CI: 1.08-2.30), p = 0.02. When patients were stratified according to DM, LDL-c ≤100 mg/dL was independently associated with increased death risk - HR = 1.55 (95% CI:1.05-2.30), p = 0.03 in patients without DM; in patients with DM no association was detected - multivariate-adjusted HR = 1.18 (95% CI: 0.77-1.80), p = 0.44. Conclusion Non-DM HF patients with LDL-c>100 mg/dL have a 35% reduction in the mortality risk when compared with those with lower values. The "cholesterol paradox" in HF also applies to LDL-c in non-DM patients.
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Affiliation(s)
- R. Gouveia
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S. Madureira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - C. Elias
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - A. Neves
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - P. Ribeirinho Soares
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M. Soares-Carreira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J. Pereira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Porto University, Portugal
| | - A. Ribeiro
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M. Amorim
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J. Almeida
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Cardiovascular R&D Centre, Faculty of Medicine, Porto University, Portugal
| | - J.P. Araújo
- Faculty of Medicine, Porto University, Portugal
- Cardiovascular R&D Centre, Faculty of Medicine, Porto University, Portugal
| | - P. Lourenco
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Porto University, Portugal
- Cardiovascular R&D Centre, Faculty of Medicine, Porto University, Portugal
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Anderson JL, May HT, Le VT, Muhlestein JB, Horne BD, Bair TL, Knight S, Knowlton KU. Impact of Statin Therapy in Heart Failure Patients: Results of a Large Real-World Experience. JACC. ADVANCES 2023; 2:100385. [PMID: 38938227 PMCID: PMC11198218 DOI: 10.1016/j.jacadv.2023.100385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/07/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2024]
Abstract
Background The use of statins in patients with heart failure (HF) is controversial. In patients without HF, statins reduce atherosclerotic cardiovascular disease (ASCVD) risk, including HF-related events. However, in some large studies, no benefit was seen in statin-treated HF patients. Objectives The purpose of this study was to determine the impact of statin therapy in HF with reduced ejection fraction (HFrEF). Methods Intermountain Healthcare medical records identified patients with a HF diagnosis and an ejection fraction of ≤40%. Patients prescribed and not prescribed a statin were compared for major adverse cardiovascular events (MACE) (death, myocardial infarction, stroke) (median of 4.5 years follow-up). Statin use was defined as use at or after a HF diagnosis but at least 60 days before MACE or end of follow-up. Cox proportional hazards regression was used to determine the relationship between statin use and outcomes. Results A total of 15,010 patients (n = 9,641 [64%] on statins) were studied. Statin use was associated with more frequent ASCVD risk factors yet a lower risk of MACE risk (adjusted HR: 0.53; 95% CI: 0.51-0.56; P < 0.0001). Benefit was similar for primary and secondary prevention patients and for prior and new statin prescriptions. Using time-varying hazard ratio analysis, the longer the patient was on a statin, the greater the reduction in risk of MACE (P < 0.0001). Conclusions These results suggest a potential benefit of selective statin use in the real-world management of HFrEF patients with ASCVD or at high ASCVD risk.
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Affiliation(s)
- Jeffrey L. Anderson
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Heidi T. May
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Viet T. Le
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
- Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Joseph B. Muhlestein
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin D. Horne
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
- Stanford University, Stanford, California, USA
| | - Tami L. Bair
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Stacey Knight
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kirk U. Knowlton
- Cardiovascular Department, Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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