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Can Statins Benefit Elderly Patients with Ischemic Heart Failure?

In a randomized trial, rosuvastatin was associated with a decrease in hospitalizations for cardiovascular events but no reduction in mortality.

Clinical trials have established statins’ benefits in patients with established coronary artery disease, but individuals with heart failure have typically been excluded from these trials. We have good reasons to believe that the balance of benefits and risks of statins may be substantially different for patients with HF than for other patients with CAD.

Investigators in this manufacturer-sponsored trial randomized 5011 patients aged 60 years (mean age, 73) with symptomatic HF attributed to CAD and LV systolic dysfunction (mean LV ejection fraction, 31%) to receive either rosuvastatin (10 mg/day) or placebo. Median follow-up time was 32.8 months. Patients in the rosuvastatin group — but not those in the placebo group — had substantially reduced LDL-cholesterol and high-sensitivity C-reactive protein levels. However, the rate of the primary composite endpoint of cardiovascular death, nonfatal MI, and nonfatal stroke did not differ significantly between the two groups (12.3 and 11.4 per 100 patient-years in the placebo and rosuvastatin groups, respectively; hazard ratio, 0.92). Patients in the rosuvastatin group had a lower risk for hospitalization for cardiovascular causes (HR, 0.92; P=0.04) and fewer hospitalizations for HF than those in the placebo group. Adverse events, including muscular symptoms, were no more frequent in the rosuvastatin group than in the placebo group, and significantly more patients discontinued placebo than rosuvastatin.

Comment: Although rosuvastatin did not significantly reduce the combined risk for cardiovascular death, MI, or stroke in older patients with ischemic systolic heart failure, it did result in fewer hospitalizations without more adverse treatment effects than placebo. Therefore, these findings should not dissuade practitioners from continuing to prescribe statins in eligible patients with HF and ischemic systolic dysfunction. However, several questions remain: Are statins generally less beneficial in patients with HF than in those without HF? Do statins’ effects lessen with age and multiple coexisting illnesses? How do rosuvastatin’s effects on health outcomes compare with those of other statins? Pending results of the GISSI-HF trial (a large, randomized, 2 x 2 factorial study of omega-3 fatty acid and rosuvastatin as adjuncts to standard HF therapy) may help to answer some of these questions.

— Frederick A. Masoudi, MD, MSPH

Published in Journal Watch Cardiology November 5, 2007

Citation(s):

Kjekshus J et al. for the CORONA group. Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007 Nov 5; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMoa0706201)

Masoudi FA. Statins for ischemic systolic heart failure. N Engl J Med 2007 Nov 5; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMe0707221)