Short-term statin therapy improves cardiac function and symptoms in patients with idiopathic dilated cardiomyopathy

Abstract

Background: Chronic heart failure is associated with inflammation and neurohormonal imbalance. The 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitors, or statins, exert anti-inflammatory and vascular protective effects. We hypothesized that short-term statin therapy may have beneficial effects in patients with nonischemic heart failure.

Methods and results: Sixty-three patients with symptomatic, nonischemic, dilated cardiomyopathy were randomly divided into 2 groups. One group received simvastatin (n=24), and the other group received placebo (n=27). The initial dose of simvastatin was 5 mg/d, which was increased to 10 mg/d after 4 weeks. After 14 weeks, patients receiving simvastatin exhibited a modest reduction in serum cholesterol level compared with patients receiving placebo (130+/-13 versus 148+/-18, P<0.05). Patients treated with simvastatin had a lower New York Heart Association functional class compared with patients receiving placebo (2.04+/-0.06 versus 2.32+/-0.05, P<0.01). This corresponded to improved left ventricular ejection fraction in the simvastatin group (34+/-3 to 41+/-4%, P<0.05) but not in the placebo group. Furthermore, plasma concentrations of tumor necrosis factor-alpha, interleukin-6, and brain natriuretic peptide were significantly lower in the simvastatin group compared with the placebo group.

Conclusions: Short-term statin therapy improves cardiac function, neurohormonal imbalance, and symptoms associated with idiopathic dilated cardiomyopathy. These findings suggest that statins may have therapeutic benefits in patients with heart failure irrespective of serum cholesterol levels or atherosclerotic heart disease.

Figure 1

Changes in NYHA classification (A) and LVEF (B) before and after 14 weeks of treatment in placebo and statin groups. *P<0.01 and **P<0.05 vs placebo group.

Figure 2

Changes in left ventricular end-diastolic volume (LVEDV) (A) or end-systolic volume (LVESV) (B) before and after 14 weeks of treatment in placebo and statin group. *P<0.05 vs placebo group.

Figure 3

Comparison of the plasma levels of BNP (A), TNF-α (B), and IL-6 (C) before and after 14 weeks of treatment between the placebo and statin groups. *P<0.001 vs placebo group. #P<0.05 vs before treatment in the statin group.

Figure 4

Comparison of the flow-dependent dilatation of brachial artery before and after 14 weeks of treatment between the placebo and statin groups. *P<0.01 vs placebo group. #P<0.01 vs before treatment in the statin group.