Statins Linked to Increased Dyspnea, Fatigue in Patients With Diastolic Heart Failure

Kristina Rebelo

November 13, 2009

November 12, 2009 (San Diego, California) — Statins might have negative effects in people with diastolic heart failure (DHF). Patients with DHF who experience increased dyspnea and fatigue during exercise might need to have their medications adjusted, according to a study released here at CHEST 2009: American College of Chest Physicians Annual Meeting.

Lead investigator and presenter Lawrence P. Cahalin, PT, PhD, gerontologist and clinical professor, Department of Physical Therapy, School of Health Professions, Northeastern University, in Boston, and colleagues there and at Massachusetts General Hospital in Boston, retrospectively reviewed the charts of 139 patients with heart failure, with the intention of looking at statin status and their effects on pulmonary function and exercise tolerance in patients with DHF and systolic heart failure (SHF).

A total of 78 patients not taking statins (82% with DHF; 55% women; mean age, 55 ± 14 years) were compared with 61 patients taking statins (72% with DHF; 34% women; mean age, 64 ± 11 years). Dr. Cahalin said that the most common statin prescribed was atorvastatin (Lipitor, Pfizer, Inc.), which is taken by 75% of statin users.

Dr. Cahalin reported that forced expiratory volume in the 1 second, forced vital capacity, and exercise tolerance were significantly lower in statin users than in nonusers (P < .05).

"I think that if a patient is on a statin and they start to report more shortness of breath or fatigue, it could possibly be due to the statin," he said. "It certainly suggests that further investigation is warranted to examine the cause and, if it is the statin, [a possible solution would be to] change to another statin or to another lipid-lowering agent altogether."

"I have seen people move from statin to statin and their symptoms seem to improve because not all statins are alike and not all patients react to statins alike," Dr. Cahalin told Medscape Pulmonary Medicine in an interview after his presentation. "It may be necessary to find one that produces fewer symptoms in these patients while also producing the favorable wanted effects of lowering cholesterol."

"Patients with systolic heart failure who were on a statin had improved pulmonary function and some exercise variables," said Dr. Cahalin, "However, in patients with diastolic heart failure, we found that there was a decrease in pulmonary function and poorer exercise tolerance — thus, [there is] an opposite effect of statins on pulmonary function and exercise in people with diastolic [and those with] systolic heart failure."

A subgroup analysis showed that pulmonary function measures in statin users with DHF were 12% lower than those in nonusers with DHF (P < .05). The peak Watts and peak oxygen uptake in statin users with DHF were lower than in nonusers with DHF (16% lower and 18% lower, respectively; < .05).

The most significant findings, according to Dr. Cahalin, were in exercise tolerance. Measures of work output at the anaerobic threshold were lower in statin users with DHF than in nonusers with DHF (47% difference; P < .05). Differences between statin users and nonusers with SHF were not significant.

He pointed out that statins have a variety of pleiotropic effects in these SHF patients, including improvement of inflammation in endothelial function. "There was a trend toward a pulmonary mechanical limit in patients with DHF on a statin, which may be due to respiratory muscle weakness, something statins are known to cause. I think that patients with diastolic heart failure may have less of an inflammatory component and, for some unknown reason, statins appear to worsen the muscles in these patients compared with patients with systolic heart failure patients on a statin."

"Inflammation is a major problem in SHF. . . . Statins seem to be helpful in patients with SHF. . .  and that is one of the reasons why, in my study, I believe, the patients with systolic heart failure benefited from the statin."

Despite the findings in some patients, the researchers told meeting attendees that the benefits of statins outweigh the risks in patients with both SHF and DHF, and that the drugs are an established standard of care.

Commenting on the study at the news conference was Kalpalatha Guntupalli, MD, FCCP, president of the American College of Chest Physicians. She said that "statins provide significant benefits for patients with cardiovascular disease. However, as for any new medication prescribed, clinicians should closely monitor the effects that different types of statins have on individual patients."

The study did not receive commercial support. Dr. Cahalin and Dr. Guntupalli have disclosed no relevant financial relationships.

CHEST 2009: American College of Chest Physicians Annual Meeting: Poster 592. Presented November 4, 2009.

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