title: Statin use and survival in patients with chronic heart failure--results from two observational studies with 5200 patients.
abstract: BACKGROUND
  There is minimal evidence that HMG-CoA reductase inhibitors (statins) are beneficial in patients with chronic heart failure (CHF). Treatment with statins may lead to a lower mortality in CHF, independent of cholesterol levels, CHF etiology and clinical status.
  
  
  METHODS
  In a first study, we included 3132 patients with CHF from the ELITE 2 study in whom information on body mass index (BMI) and statin use at baseline were available. In a second study, we pooled the databases of 5 tertiary referral centers with 2068 CHF patients. In this cohort 705 patients were on a statin (34%), 585 of 1202 (49%) patients with ischemic etiology, and 120 of 866 (14%) patients with non-ischemic etiology (established by coronary angiography).
  
  
  RESULTS
  Patients in ELITE 2 who received statin therapy at baseline (n=397, 13%) had lower mortality (hazard ratio [HR] 0.61, 95% CI 0.45-0.83; p=0.0007). In univariate analysis, increasing age, NYHA class, creatinine, and decreasing BMI, LVEF, and cholesterol, as well as lack of beta-blocker treatment and ischemic etiology (all p<0.002) related to higher mortality. In multivariable analysis, statin therapy related to lower mortality independently of all these variables (adjusted HR 0.66, 95% CI 0.47-0.93; p=0.017). In the second study CHF patients on statins had lower mortality (adjusted HR 0.58, 95% CI 0.44-0.77; p=0.0001). Both in patients with ischemic (p<0.0001) and non-ischemic etiology (p=0.028) statin treatment related to better survival.
  
  
  CONCLUSIONS
  In chronic heart failure, treatment with statins is related to lower mortality, independent of cholesterol levels, disease etiology and clinical status.
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany. s.anker@imperial.ac.uk
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: Ralf
authors.initials: R
authors.lastname: Winkler
authors.forename: Christian
authors.initials: C
authors.lastname: Zugck
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Constantinos H
authors.initials: CH
authors.lastname: Davos
authors.forename: Waldemar
authors.initials: W
authors.lastname: Banasiak
authors.forename: Piero
authors.initials: P
authors.lastname: Zardini
authors.forename: Markus
authors.initials: M
authors.lastname: Haass
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Andrew J S
authors.initials: AJ
authors.lastname: Coats
authors.forename: Philip A
authors.initials: PA
authors.lastname: Poole-Wilson
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002216:Captopril / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010101:Oxygen Consumption; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002216:Captopril; D019808:Losartan