Statins 'Modestly' Lower Risk of Heart Failure in Large Meta-Analysis of Major Trials

March 24, 2015

GLASGOW, SCOTLAND – A large meta-analysis investigating the effects of statin therapy on heart failure shows the lipid-lowering therapy used for more than 4 years significantly reduced the number of patients hospitalized for heart failure but did not reduce the risk of heart-failure mortality[1].

Among 132 538 individuals participating in 17 primary- and secondary-prevention studies, statin therapy reduced the risk of heart-failure hospitalizations by 10% compared with the control arm. There was also a significant 8% reduction in the composite end point of heart-failure mortality and hospitalizations, but this reduction was driven by the decrease in heart-failure hospitalizations.

To heartwire from Medscape, lead investigator Dr David Preiss (University of Glasgow, Scotland) said the 10% relative reduction in risk might appear small, but he suspects the event curves are only just beginning to diverge. Four-year follow-up, he suspects, is simply too short a time period to observe reductions in heart-failure hospitalizations or deaths.

"I think we're only beginning to see the benefits of statins on heart-failure end points," he said.

For example, he pointed to the long-term data from the West of Scotland Coronary Prevention Study (WOSCOPS), a landmark primary-prevention study in men with elevated cholesterol levels. Regarding the heart-failure benefit with pravastatin over placebo, none was observed in the first 5 years, but by 15 years statin therapy reduced heart-failure hospitalizations by 43%.

"When we look at 15-year WOSCOPS data, which is published, and the 20-year data that has now been presented a few times, the event curves for the development of heart failure diverged as time has gone on even though the initial findings in the trial, the treatment period, really didn't show too much that was convincing," said Preiss. "One would suspect that we would see a similar pattern if we could look at the statin trials long term."

Four Years Follow-Up Relatively Short

The meta-analysis, which was presented here this week at EAS 2015: the European Atherosclerosis 2015 Congress, and published online March 23, 2015 in the European Heart Journal, included unpublished data from 17 trials. The trials were a mix of statin studies, including placebo-controlled trials, standard-care–controlled trials, and intensive-vs-moderate–dose trials. The cohort was an eclectic group, including primary-prevention studies, secondary-prevention studies, and mixed primary- and secondary trials.

Overall, statin therapy lowered LDL-cholesterol levels by 37.4 mg/dL (0.97 mmol/L) and reduced the risk of MI by 26%. As noted, heart-failure hospitalizations were reduced 10% over the 4.2-year follow-up period. There was no effect on heart-failure mortality.

The researchers also wanted to determine the influence of statins on heart-failure events that were preceded and not preceded by MI. To do this, they analyzed the relative reduction in risk of heart failure among patients who had an MI before a diagnosis of heart failure and in those who had an MI subsequent to heart failure.

"For those who suffered a first nonfatal heart-failure hospitalization, there's two ways you can get there," said Preiss. "Either you progress to that event without having had an MI or you potentially first have an MI and this then leads to subsequent heart-failure hospitalizations. We wanted to know if the MI reduction [with statins] was driving the reduction in heart failure."

Approximately 10% to 15% of first heart-failure events were preceded by a nonfatal MI. For these patients, statins reduced the risk of a heart-failure event (death or hospitalization) by 13%, although this reduction was not statistically significant. Among those without an MI prior to heart failure, statins lowered the relative risk by a significant 9% compared with controls.

During the session, Preiss said he suspects the benefits of statin therapy on the reduction of heart-failure events is derived through a lowering of ischemic heart disease risk. The researchers didn't observe any difference across various subgroups, including the primary- and secondary-prevention studies or studies comparing high-dose vs low-dose statin therapy.

Preiss reports no relevant financial relationships. Disclosures for the coauthors are listed in the article.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....