title: Should a statin be prescribed to every patient with heart failure?
abstract: Chronic heart failure (HF) represents an emerging epidemic since its prevalence is continuously increasing despite advances in treatment. Many recent clinical studies have clearly demonstrated that statin therapy is associated with improved outcomes in HF irrespective of aetiology (ischaemic or not) or baseline cholesterol levels. Indeed, most of the conducted large statin trials and trials in HF have demonstrated a positive effect of statins in HF patients. Furthermore, the use of statins in HF seems to be safe as none of the recent trials has resulted in worse outcomes for HF patients treated with statins. Potential mechanisms through which statins could benefit the failing myocardium include non-sterol effects of statins, as well as effects on nitric oxide and endothelial function, inflammation and adhesion molecules, apoptosis and myocardial remodelling and neurohormonal activation. This review discusses the pathophysiological basis of statin effects on HF and focuses on clinical data for the benefit from statin use in this setting. Until today there are no official recommendations in both the American and the European guidelines regarding the use of statins in HF patients, as the available data come from small observational or larger but retrospective, non-randomised studies. Therefore, HF patients should be treated according to current lipid guidelines. Large randomised clinical trials are underway and will further delineate the role of statin therapy in HF patients. Until more data are available, we could not recommend statin use to every patient with HF irrespective of HF aetiology and baseline cholesterol levels.
authors: Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina 45110, Greece. stsouli@hotmail.com
authors: Sofia G
authors: SG
authors: Tsouli
authors: Evangelos N
authors: EN
authors: Liberopoulos
authors: John A
authors: JA
authors: Goudevenos
authors: Dimitri P
authors: DP
authors: Mikhailidis
authors: Moses S
authors: MS
authors: Elisaf
mesh_terms: D002986:Clinical Trials as Topic; D011307:Drug Prescriptions; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
references: Heart Fail Rev. 2003 Jan;8(1):99-106
references: 12652163
references: Am J Cardiol. 2006 Mar 15;97(6):899-904
references: 16516598
references: Am J Kidney Dis. 2006 Mar;47(3):561; author reply 562
references: 16490637
references: Cardiovasc Drugs Ther. 2005 May;19(3):167-8
references: 16142591
references: J Card Fail. 2005 Dec;11(9):684-90
references: 16360963
references: Lancet. 1999 May 29;353(9167):1838-42
references: 10359409
references: Circulation. 2006 Feb 7;113(5):671-8
references: 16461840
references: Eur J Heart Fail. 2001 Jun;3(3):315-22
references: 11378002
references: Eur J Heart Fail. 2001 Jun;3(3):381-7
references: 11378012
references: Eur J Heart Fail. 2004 Aug;6(5):635-41
references: 15302013
references: Am Heart J. 2004 Oct;148(4):635-40
references: 15459594
references: Acta Cardiol. 2005 Oct;60(5):489-92
references: 16261779
references: J Cell Biochem. 1997 Jul 1;66(1):43-53
references: 9215527
references: J Clin Invest. 1998 Jun 15;101(12):2711-9
references: 9637705
references: BMC Med. 2005 Mar 16;3:6
references: 15771782
references: Nature. 2002 Dec 12;420(6916):629-35
references: 12478284
references: JAMA. 2004 Sep 15;292(11):1307-16
references: 15337732
references: Am Heart J. 2000 Jan;139(1 Pt 1):72-7
references: 10618565
references: Circulation. 2003 Aug 19;108(7):839-43
references: 12885745
references: Arch Intern Med. 2005 Jan 10;165(1):62-7
references: 15642876
references: N Engl J Med. 1996 Oct 3;335(14):1001-9
references: 8801446
references: Hellenic J Cardiol. 2005 May-Jun;46(3):208-11
references: 15981556
references: Minerva Cardioangiol. 2004 Dec;52(6):465-77
references: 15729208
references: Arch Intern Med. 2001 Apr 9;161(7):996-1002
references: 11295963
references: N Engl J Med. 1990 Jul 26;323(4):236-41
references: 2195340
references: Am J Cardiol. 2005 Dec 15;96(12):1699-704
references: 16360360
references: Circulation. 2003 Apr 22;107(15):1991-7
references: 12707250
references: Am J Kidney Dis. 2004 Apr;43(4):589-99
references: 15042535
references: J Am Coll Cardiol. 2006 Jan 17;47(2):338-41
references: 16412857
references: Eur J Heart Fail. 2005 Jun;7(4):468-74
references: 15921781
references: Lancet. 2000 Sep 9;356(9233):930-3
references: 11036910
references: Atherosclerosis. 2005 Mar;179(1):201-6
references: 15721028
references: Circulation. 2005 Jul 19;112(3):357-63
references: 16009792
references: Mol Aspects Med. 1997;18 Suppl:S137-44
references: 9266515
references: Lancet. 2005 May 21-27;365(9473):1766
references: 15910945
references: Cardiovasc Res. 2003 Nov 1;60(2):250-8
references: 14613854
references: JAMA. 2005 Feb 2;293(5):572-80
references: 15687312
references: Circulation. 2006 May 16;113(19):2363-72
references: 16702489
references: Curr Med Res Opin. 2005 Feb;21(2):231-44
references: 15801994
references: J Am Coll Cardiol. 2006 Jan 17;47(2):332-7
references: 16412856
references: J Am Coll Cardiol. 2004 Feb 18;43(4):642-8
references: 14975476
references: Eur Heart J. 2001 Feb;22(3):228-36
references: 11161934
references: Heart. 2004 Apr;90(4):464-70
references: 15020532
references: Clin Cardiol. 2004 May;27(5):295-9
references: 15188947
references: Cardiovasc Res. 2005 Jun 1;66(3):427-9
references: 15914106
references: Obes Rev. 2005 Nov;6(4):283-96
references: 16246214
references: Curr Drug Targets. 2006 Feb;7(2):211-28
references: 16475962
references: Int Heart J. 2005 Sep;46(5):845-54
references: 16272775
references: Ter Arkh. 1989;61(5):68-9
references: 2781495
references: Eur Heart J. 1997 Mar;18(3):470-9
references: 9076385
references: Curr Med Res Opin. 2002;18(4):220-8
references: 12201623
references: J Cardiovasc Pharmacol. 1999 Mar;33(3):473-8
references: 10069684
references: N Engl J Med. 2005 Apr 7;352(14):1425-35
references: 15755765
references: Circulation. 2003 Apr 22;107(15):1951-3
references: 12707249
references: J Am Coll Cardiol. 2003 Dec 3;42(11):1933-40
references: 14662255
references: Science. 1995 Apr 14;268(5208):221-5
references: 7716512
references: Cell Mol Immunol. 2005 Dec;2(6):433-7
references: 16426493
references: N Engl J Med. 1998 Nov 5;339(19):1349-57
references: 9841303
references: Nat Med. 2000 Sep;6(9):1004-10
references: 10973320
references: Circulation. 2003 Sep 30;108(13):1567-74
references: 12963641
references: Atherosclerosis. 2005 Feb;178(2):387-97
references: 15694949
references: Circulation. 2002 Apr 9;105(14):1727-33
references: 11940554
references: Vascul Pharmacol. 2005 Apr-May;42(5-6):265-70
references: 15922259
references: Cardiology. 1999;91(4):215-9
references: 10545675
references: Cardiovasc Drugs Ther. 2005 May;19(3):183-7
references: 16142595
references: Eur J Heart Fail. 2005 Dec;7(7):1126-32
references: 16051518
references: Arch Intern Med. 2004 Oct 25;164(19):2162-8
references: 15505131
references: J Clin Invest. 1989 May;83(5):1774-7
references: 2540223
references: J Clin Pathol. 2004 Jul;57(7):728-34
references: 15220366
references: Eur Heart J. 2003 Sep;24(17):1601-10
references: 12964575
references: JAMA. 2001 May 16;285(19):2486-97
references: 11368702
references: J Am Coll Cardiol. 2007 Jan 23;49(3):311-9
references: 17239712
references: Atherosclerosis. 2004 Jul;175(1):187
references: 15186966
references: Eur Heart J. 1997 May;18(5):858-65
references: 9152657
references: Circulation. 2003 Jul 1;107(25):3133-40
references: 12796126
references: Curr Med Res Opin. 2006 Mar;22(3):511-28
references: 16574035
references: Circulation. 2006 Feb 28;113(8):1086-92
references: 16490817
references: Proc Natl Acad Sci U S A. 1987 Dec;84(24):9265-9
references: 2827174
references: J Hum Hypertens. 2006 May;20(5):320-35
references: 16511505
references: J Am Coll Cardiol. 2006 Jun 6;47(11):2326-31
references: 16750703
references: Circulation. 1998 Mar 31;97(12):1129-35
references: 9537338
references: Drugs. 1990;39 Suppl 4:10-21; discussion 22-4
references: 2354670
references: Am J Cardiol. 2004 May 1;93(9):1124-9
references: 15110204
references: J Cardiovasc Pharmacol Ther. 2006 Mar;11(1):1-15
references: 16703216
references: Lancet. 2002 Jul 6;360(9326):7-22
references: 12114036
references: Circ Res. 2002 Nov 29;91(11):988-98
references: 12456484
references: Hellenic J Cardiol. 2005 Jan-Feb;46(1):5-8
references: 15807388
references: Circulation. 2001 Jan 23;103(3):357-62
references: 11157685
references: Circulation. 2003 May 20;107(19):2493-8
references: 12695293
references: J Am Coll Cardiol. 2004 Nov 2;44(9):1772-9
references: 15519006
references: J Card Fail. 1997 Dec;3(4):249-54
references: 9547437
references: Curr Opin Lipidol. 2005 Dec;16(6):630-4
references: 16276240
references: Hellenic J Cardiol. 2006 Mar-Apr;47(2):51-3
references: 16752523
references: Am Heart J. 1999 Aug;138(2 Pt 1):273-84
references: 10426839
references: Circulation. 2000 Aug 8;102(6):611-6
references: 10931799
references: JAMA. 2005 Nov 16;294(19):2437-45
references: 16287954
references: Science. 1998 Jan 23;279(5350):509-14
references: 9438836
references: Biofactors. 2003;18(1-4):79-89
references: 14695923
references: Z Kardiol. 2004 Feb;93(2):103-8
references: 14963675
references: Proc Natl Acad Sci U S A. 1992 Apr 15;89(8):3362-6
references: 1314387
references: J Biol Chem. 1998 Sep 11;273(37):24266-71
references: 9727051
references: Circulation. 1999 Jun 29;99(25):3224-6
references: 10385494
references: Am J Cardiol. 2006 Apr 15;97(8):1165-71
references: 16616020
references: Circulation. 2004 Jul 13;110(2):227-39
references: 15249516
references: BMC Nephrol. 2006 Mar 06;7:3
references: 16515712
references: Eur Heart J. 2005 Jun;26(11):1115-40
references: 15901669
references: Eur J Vasc Endovasc Surg. 2004 Jan;27(1):6-16
references: 14652831
references: Ann Med. 2003;35(6):398-403
references: 14572163
references: Circulation. 2002 Feb 19;105(7):868-73
references: 11854129
references: Heart Rhythm. 2006 Aug;3(8):881-6
references: 16876733
references: Lancet. 2002 Nov 23;360(9346):1623-30
references: 12457784
references: Int J Cardiol. 2005 Oct 20;105(1):67-73
references: 16207547
references: Am J Cardiol. 2005 Mar 1;95(5):619-22
references: 15721103
references: Hypertension. 2002 Jan;39(1):87-92
references: 11799084
references: Cardiovasc Res. 2006 Aug 1;71(3):443-54
references: 16730683
references: J Card Fail. 2006 Mar;12(2):134-8
references: 16520262
references: Am J Cardiol. 2004 Nov 1;94(9):1166-8
references: 15518612
references: Circ Res. 2000 Jun 9;86(11):1107-13
references: 10850960
references: Eur J Heart Fail. 2005 Oct;7(6):1059-69
references: 16227145
references: J Pharmacol Exp Ther. 1997 Feb;280(2):839-45
references: 9023298
references: Timely Top Med Cardiovasc Dis. 2005 Feb 04;9:E1
references: 15824760
references: Curr Atheroscler Rep. 2003 Sep;5(5):372-8
references: 12911847
references: J Card Fail. 2005 Oct;11(8):607-12
references: 16230264
references: Circulation. 2007 Feb 6;115(5):576-83
references: 17261662
references: Atherosclerosis. 2005 Feb;178(2):359-63
references: 15694946
references: N Engl J Med. 2002 Aug 1;347(5):305-13
references: 12151467
references: Ann Intern Med. 2004 Jun 1;140(11):857-66
references: 15172899
references: Heart. 2005 Jan;91(1):1-2
references: 15604317
references: J Heart Lung Transplant. 2005 Aug;24(8):1114-7
references: 16102449
references: Heart. 2006 Oct;92(10):1409-13
references: 16717067
references: J Am Coll Cardiol. 2004 Oct 19;44(8):1587-92
references: 15489090
references: Cardiology. 1998 Mar;89(3):184-8
references: 9570432
references: JAMA. 2006 Nov 1;296(17):2105-11
references: 17077375
references: Clin Cardiol. 2000 Jul;23(7 Suppl 4):IV4-8
references: 10894449
references: Eur Heart J. 1998 Dec;19(12):1814-22
references: 9886724
references: Am J Cardiol. 1996 May 1;77(11):1017-20
references: 8644628
references: Cardiovasc Res. 2003 Nov 1;60(2):217-9
references: 14613847
references: Am Heart J. 2006 Sep;152(3):514-20
references: 16923423
references: J Card Fail. 2006 Aug;12(6):464-72
references: 16911914
references: Am J Physiol Heart Circ Physiol. 2004 Apr;286(4):H1425-32
references: 14644762
references: Coron Artery Dis. 2004 Aug;15(5):247-50
references: 15238820
references: Am J Med Sci. 2006 Dec;332(6):361-3
references: 17170629
references: Metabolism. 2006 Oct;55(10):1293-301
references: 16979398
references: Circulation. 2005 May 10;111(18):2356-63
references: 15867181
references: Angiology. 2002 Sep-Oct;53(5):493-502
references: 12365855
references: J Card Fail. 2002 Aug;8(4):216-24
references: 12397569
references: Circulation. 1998 Apr 21;97(15):1453-60
references: 9576425
references: Am J Cardiol. 2004 Mar 1;93(5):603-6
references: 14996587
references: J Am Coll Cardiol. 2006 Feb 21;47(4):769-73
references: 16487843
references: Arterioscler Thromb Vasc Biol. 1995 Oct;15(10):1652-9
references: 7583540
references: J Am Coll Cardiol. 2006 Jan 17;47(2):342-4
references: 16412858
references: JAMA. 2001 Apr 4;285(13):1711-8
references: 11277825