Debate: Statins should be used in patients with heart failure.
Treatment to prevent progression of heart failure has been targeted to reverse the consequences of heart failure and to a lesser extent the cause - the atherosclerotic plaque itself. Less than 50% of patients with heart failure are treated with lipid intervention. Heart failure (New York Heart Association [NYHA] functional classes I and II) is associated with an increase in low-density lipoproteins (LDL) and triglycerides while high-density lipoproteins (HDL) is lowered. In NYHA class IV, cholesterol is reduced due to depressed production in the liver. Although lipoproteins, especially LDL and HDL, may have some protective effect in binding and neutralising endotoxins released from the intestine during terminal heart failure, observational studies in patients with heart failure strongly suggest that lipid modification with statins may reduce progression of heart failure as well as reducing heart failure mortality.
Kjekshus
John
J
Department of Cardiology, Rikshospitalet, Oslo, Norway. john.kjekshus@klinmed.uio.no