Impact of Statin Therapy in Heart Failure Patients: Results of a Large Real-World Experience.

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.
Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN MEDICAL KNOWLEDGE: Statin treatment in patients with HFrEF is associated with a lower risk of MACE during follow-up. This benefit is observed both in the primary and for the secondary risk cohorts. Furthermore, the longer the patient was on a statin, the greater the reduction in risk of a cardiovascular event. COMPETENCY IN PATIENT CARE: The use of statins in patients with HF is controversial. Discussions with the patient about the potential benefit of statin therapy should be made. TRANSLATIONAL OUTLOOK: Although this is an observational study, it provides additional evidence of statin benefit in HF patients and the need for future pragmatic, clinical trials.
(© 2023 The Authors.)