Statin use and survival outcomes in elderly patients with heart failure.
BACKGROUND
Coronary artery disease is a leading cause of heart failure. Statins are efficacious drugs for the primary and secondary prevention of coronary heart disease, but their value in persons with heart failure remains unknown.


METHODS
We performed a population-based retrospective cohort study involving the entire province of Ontario, Canada, restricting participants to those aged 66 to 85 years who were free of cancer and who survived at least 90 days following hospitalization for newly diagnosed heart failure. The primary study outcome was the risk of death from all causes, nonfatal acute myocardial infarction, or nonfatal stroke among persons newly dispensed statins (n = 1,146) relative to those who were not (n = 27,682).


RESULTS
The mean age of all participants was 76.5 years, and half were women. During the 7-year study period, death, acute myocardial infarction, or stroke occurred in 217 statin recipients (13.6 per 100 person-years) vs 12,299 nonrecipients (21.8 per 100 person-years; adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.63-0.83). Most of the benefit from statins was related to a reduction in all-cause mortality (adjusted HR, 0.67; 95% CI, 0.57-0.78). No significant reduction was seen for subsequent myocardial infarction (adjusted HR, 0.81; 95% CI, 0.63-1.03) or stroke (adjusted HR, 0.81; 95% CI, 0.53-1.25).


CONCLUSIONS
Statin use is associated with a lower risk of death among seniors newly diagnosed as having congestive heart failure. While statin use has been previously shown to be efficacious in patients with coronary heart disease and stroke, we could not control for all prognostic risk factors in the present study, including left ventricular ejection fraction and serum lipid levels. Better evidence can direct clinicians about which patients with heart failure might benefit from these drugs.
Ray
Joel G
JG
Department of Medicine, St Michaels Hospital, University of Toronto, Ontario M5B 1W8, Canada. rayj@smh.toronto.on.ca
Gong
Yanyan
Y
Sykora
Kathy
K
Tu
Jack V
JV
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D003324:Coronary Artery Disease / Q000150:complications / Q000517:prevention & control; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D016017:Odds Ratio; D009864:Ontario; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy; D016019:Survival Analysis; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors