Statins and symptomatic chronic systolic heart failure: a post-hoc analysis of 5010 patients enrolled in Val-HeFT

Abstract

Background: Statins prolong survival in patients at high risk for cardiovascular events, however little is known regarding their efficacy and safety in patients with established chronic heart failure (CHF). To address this, we retrospectively analyzed the Valsartan Heart Failure Trial (Val-HeFT) database to determine outcomes in CHF patients according to statin use at baseline.

Methods: Demographic characteristics of patients receiving statins at baseline (n=1602) were compared with those who were not (n=3048). A multivariate Cox proportional hazards model, with death as outcome, was used to assess the impact of statin therapy, with adjustment made for baseline differences in relevant parameters.

Results: Patients receiving statins at baseline were younger with fewer females, fewer in NYHA III-IV, more with an ischemic etiology, more diabetics, higher BMI, lower SBP, more on beta-blockers, but no difference in LVEF or ACEi use. Mortality over a mean 2-year follow-up was 17.9% on statins versus 20.3% without statins (p=0.029). Cox-adjusted hazard ratio for statins was 0.81 [95% CI 0.70-0.94]. No statistically significant interaction was found between statins and valsartan for mortality. After 4 months, the only laboratory changes were a reduction in CRP and an attenuation of the rise in norepinephrine in the statin group.

Conclusions: In a large, contemporary sample of patients with CHF, statin use appeared to be associated with a lower 2-year mortality. These findings suggest a prognostic benefit for statins in established CHF, however prospective data are required to definitively address this issue.

Condensed abstract: We examined major cardiovascular outcomes in patients who were (n=1602) and were not (n=3048) receiving statins at baseline in the Val-HeFT cohort of patients with mild to moderate systolic chronic heart failure. Mortality was reduced in patients receiving statins compared to those who were not, without any significant interaction effect between statin treatment and valsartan. These findings suggest a prognostic benefit for statins in established heart failure, however prospective data are required to definitively address this issue.