Statin therapy and mortality among patients hospitalized with heart failure and preserved left ventricular function--a preliminary report.
BACKGROUND
A number of medications such as beta-blockers,ACE-inhibitors, angiotensin receptor blockers and aldosterone antagonists, improve survival in patients with heart failure (HF) and reduced ejection fraction. No therapy has been proved to be beneficial for patients with heart failure and preserved ejection fraction (PLVEF).


OBJECTIVE
The aim of the study was to assess the effect of statin therapy on all-cause mortality and cardiovascular rehospitalization rate in patients with HF and PLVEF during one-year follow-up.


METHODS
We evaluated 146 patients with HF and PLVEF (ejection fraction > or = 45%). Patients were divided into the statin therapy group (n = 103, mean age 69 +/- 11 y, 52 men) and the group without statins (n = 43, mean age 66 +/- 16 y, 25 men).We analysed the effects of the statin treatment prescribed to patients at discharge. Patients were followed up for one year.


RESULTS
The age, gender, NYHA functional class, prevalence of co-morbidities (renal dysfunction, COPD, diabetes mellitus) did not differ between the groups (P = NS). Patients receiving statin therapy more frequently had an ischaemic aetiology of HF (79% vs. 39.5%; P < 0.001) and hypertension (76% vs. 58%; P < 0.05). No differences in ejection fraction were observed neither by echocardiography (58% vs. 55%; P = NS) nor by basic laboratory data. Patients who received statins were often additionally treated with beta-blockers (91% vs. 70%; P < 0.005), aspirin (77 vs. 44%; P < 0.01), thienopyridines (22% vs. 5%; P < 0.01) and less frequently with oral anticoagulants (5% vs. 23%; P < 0.005). In the group receiving statins a significantly lower mortality (4% vs. 21%; P < 0.001) and rehospitalization rate (43% vs. 69%; P < 0.05) was documented. After adjustment for all univariate predictors of the occurrence of study primary end-points, statin therapy was shown to be associated with significant and independent reduction in all-cause mortality (HR = 0.24 [95%CI:0.07 - 0.90] P < 0.05) and cardiovascular rehospitalization rate (HR = 0.55 [95%CI: 0.33 - 0.92] P< 0.05). After propensity matching statin therapy remained an independent factor reducing one-year mortality rate (HR = 0. 11 [95%CI: 0.01 - 0.99] P < 0.05].


CONCLUSIONS
This study showed that statin therapy may have beneficial effects on mortality and rehospitalization rates among patients with HF and PLVEF. It also suggests a potential role for statins as a new therapeutic option in patients with HF and PLVEF, but these observations need to be confirmed in large randomized trials.
Roik
Marek
M
Department of Cardiology, Medical University, Warsaw, Poland. mfroik@amwaw.edu.pl
Starczewska
Małgorzata H
MH
Huczek
Zenon
Z
Kochanowski
Janusz
J
Opolski
Grzegorz
G
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013318:Stroke Volume; D016277:Ventricular Function, Left