title: Intensive statin therapy and the risk of hospitalization for heart failure after an acute coronary syndrome in the PROVE IT-TIMI 22 study.
abstract: 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.
authors.affiliation: TIMI Study Group, Cardiovascular Division, Department of Medicine, Boston, Massachusetts 02115 , USA. bscirica@partners.org
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Scirica
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.forename: Marc S
authors.initials: MS
authors.lastname: Sabatine
authors.forename: Petr
authors.initials: P
authors.lastname: Jarolim
authors.forename: Amy
authors.initials: A
authors.lastname: Shui
authors.forename: Carolyn H
authors.initials: CH
authors.lastname: McCabe
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: 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
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D020097:Natriuretic Peptide, Brain; D000069059:Atorvastatin; D017035:Pravastatin