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Review
. 2015 Jun 21;36(24):1536-46.
doi: 10.1093/eurheartj/ehv072. Epub 2015 Mar 23.

The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials

David Preiss  1 , Ross T Campbell  2 , Heather M Murray  3 , Ian Ford  3 , Chris J Packard  4 , Naveed Sattar  2 , Kazem Rahimi  5 , Helen M Colhoun  6 , David D Waters  7 , John C LaRosa  8 , Pierre Amarenco  9 , Terje R Pedersen  10 , Matti J Tikkanen  11 , Michael J Koren  12 , Neil R Poulter  13 , Peter S Sever  13 , Paul M Ridker  14 , Jean G MacFadyen  14 , Scott D Solomon  14 , Barry R Davis  15 , Lara M Simpson  15 , Haruo Nakamura  16 , Kyoichi Mizuno  17 , Rosa M Marfisi  18 , Roberto Marchioli  18 , Gianni Tognoni  18 , Vasilios G Athyros  19 , Kausik K Ray  13 , Antonio M Gotto  20 , Michael B Clearfield  21 , John R Downs  22 , John J McMurray  2
Affiliations
Review

The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials

David Preiss et al. Eur Heart J. .

Abstract

Aims: The effect of statins on risk of heart failure (HF) hospitalization and HF death remains uncertain. We aimed to establish whether statins reduce major HF events.

Methods and results: We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled endpoint statin trials from 1994 to 2014. Collaborating trialists provided unpublished data from adverse event reports. We included primary- and secondary-prevention statin trials with >1000 participants followed for >1 year. Outcomes consisted of first non-fatal HF hospitalization, HF death and a composite of first non-fatal HF hospitalization or HF death. HF events occurring <30 days after within-trial myocardial infarction (MI) were excluded. We calculated risk ratios (RR) with fixed-effects meta-analyses. In up to 17 trials with 132 538 participants conducted over 4.3 [weighted standard deviation (SD) 1.4] years, statin therapy reduced LDL-cholesterol by 0.97 mmol/L (weighted SD 0.38 mmol/L). Statins reduced the numbers of patients experiencing non-fatal HF hospitalization (1344/66 238 vs. 1498/66 330; RR 0.90, 95% confidence interval, CI 0.84-0.97) and the composite HF outcome (1234/57 734 vs. 1344/57 836; RR 0.92, 95% CI 0.85-0.99) but not HF death (213/57 734 vs. 220/57 836; RR 0.97, 95% CI 0.80-1.17). The effect of statins on first non-fatal HF hospitalization was similar whether this was preceded by MI (RR 0.87, 95% CI 0.68-1.11) or not (RR 0.91, 95% CI 0.84-0.98).

Conclusion: In primary- and secondary-prevention trials, statins modestly reduced the risks of non-fatal HF hospitalization and a composite of non-fatal HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not.

Keywords: Heart failure; Meta-analysis; Prevention; Randomized trial; Statin.

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Figures

Figure 1
Figure 1
Flow diagram of literature search to identify randomized placebo-controlled trials, standard care-controlled trials, and dose-comparison statin trials.
Figure 2
Figure 2
The effect of statin therapy on the risk of (A) first non-fatal heart failure hospitalization in 17 trials (B) heart failure death in 14 trials (C) first composite heart failure outcome in 14 trials. All heart failure events within 30 days of myocardial infarction were excluded.
Figure 3
Figure 3
Funnel plot for non-fatal heart failure hospitalization. Egger test P = 0.74.
None
See this image and copyright information in PMC

Comment in

  • Are statins failing in heart failure?
    Kjekshus J. Kjekshus J. Eur Heart J. 2015 Jun 21;36(24):1502-4. doi: 10.1093/eurheartj/ehv133. Epub 2015 Apr 16. Eur Heart J. 2015. PMID: 25883176 No abstract available.

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