Intensive statin therapy and the risk of hospitalization for heart failure after an acute coronary syndrome in the PROVE IT-TIMI 22 study.
OBJECTIVE
We aimed to determine whether intensive statin therapy reduces hospitalization for heart failure (HF) in high-risk patients.


BACKGROUND
While the relationship between intensive statin therapy and ischemic events is well established, its relationship to the risk of HF after an acute coronary syndrome (ACS) is not well defined.


METHODS
The Pravastatin or Atorvastatin Evaluation and Infection Trial-Thrombolysis In Myocardial Infarction 22 (PROVE IT-TIMI 22) study randomized 4,162 patients, stabilized after ACS, to either intensive statin therapy (atorvastatin 80 mg) or moderate statin therapy (pravastatin 40 mg). Hospitalization for HF occurring more than 30 days after randomization was determined during a mean follow-up of 24 months. B-type natriuretic peptide (BNP) levels were measured at baseline (median seven days after randomization).


RESULTS
Treatment with atorvastatin 80 mg significantly reduced the rate of hospitalization for HF (2.3% vs. 3.9%, [corrected] hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.45 to 0.91, p = 0.012) [corrected] independently of a recurrent myocardial infarction or prior history of HF. The risk of HF increased steadily with increasing quartiles of BNP (HR 2.45, 95% CI 1.33 to 4.52, p = 0.004 [corrected] for the highest quartile compared with the lowest). Among patients with elevated levels of BNP (>80 pg/ml), treatment with atorvastatin significantly reduced the risk of HF compared with pravastatin (HR 0.50, 95% CI 0.27 to 0.93, p = 0.028). [corrected]. A meta-analysis of four trials that included 27,546 patients demonstrates a 27% reduction in the odds of hospitalization for HF with intensive statin therapy.


CONCLUSIONS
Intensive statin therapy reduces the risk of hospitalization for HF after ACS with the most gain in patients with elevated levels of BNP.
Scirica
Benjamin M
BM
TIMI Study Group, Cardiovascular Division, Department of Medicine, Boston, Massachusetts 02115 , USA. bscirica@partners.org
Morrow
David A
DA
Cannon
Christopher P
CP
Ray
Kausik K
KK
Sabatine
Marc S
MS
Jarolim
Petr
P
Shui
Amy
A
McCabe
Carolyn H
CH
Braunwald
Eugene
E
D000208:Acute Disease; D000069059:Atorvastatin; D002303:Cardiac Output, Low / Q000097:blood / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D003327:Coronary Disease / Q000150:complications*; D006538:Heptanoic Acids / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D017035:Pravastatin / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013577:Syndrome
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D020097:Natriuretic Peptide, Brain; D000069059:Atorvastatin; D017035:Pravastatin