The effects of initiation or continuation of statin therapy on cholesterol level and all-cause mortality after the diagnosis of left ventricular systolic dysfunction.
BACKGROUND
Statins (3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors) are known to reduce mortality and cardiac events in patients with coronary artery disease who have not progressed to left ventricular systolic dysfunction (LVSD) and/or heart failure (HF). This study investigated the effect of changes in statin therapy and cholesterol level on mortality in patients with LVSD.


METHODS
Data from consecutive patients with LVSD enrolled in a single local hospital HF management program were analyzed. Patients were grouped according to changes in statin treatment within 4 months after their initial visit: groups NS (no statin), IS (initiation of statin), CS (continuation of statin), and SS (statin stopped).


RESULTS
Nine hundred patients were followed for a median of 36 (28-43) months (range, 16-66 months). The 2-year mortality was 16.7%. Groups IS and CS had lower 2-year mortality than groups NS and SS (11.0% and 11.9% vs 22.0% and 34.8%, respectively; P < .001). This was independent of age, sex, severity of LVSD, HF medications, New York Heart Association functional class, and baseline cholesterol. The effect was mainly observed in patients with coronary artery disease. In 734 patients who had completed 1-year follow-up on stable HF treatment, neither baseline cholesterol nor change over 1 year predicted outcome.


CONCLUSIONS
Initiation and maintenance of treatment with statins is associated with better survival in patients with LVSD. This could not be explained by other measured variables.
Huan Loh
Poay
P
Academic Cardiology Department, University of Hull, Hull Royal Infirmary, Hull, UK. huan.loh@hey.nhs.uk
Windram
Jonathan D
JD
Tin
Lwin
L
Reddy
Priya
P
Velavan
Periaswamy
P
Rigby
Alan S
AS
Atkin
Paul
P
Nikitin
Nikolay P
NP
Clark
Andrew L
AL
Cleland
John G F
JG
D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol