Lipid-lowering drugs and heart failure: where do we go after the statin trials?
OBJECTIVE
Heart failure is an important cause of disease burden in aging societies. Although HMG-CoA reductase inhibitors (statins) prevent important causative factors for heart failure, myocardial damage and ischemia, the benefits of statins and low-density lipoprotein (LDL) lowering in heart failure patients have been questioned. The role of other types of dyslipidemia [low high-density lipoprotein (HDL), high triglycerides] and their modification has received less attention in heart failure thus far.


RESULTS
In patients with coronary artery disease (CAD), or at high risk thereof, statin treatment prevents heart failure. Moreover, intensive statin treatment is better than usual doses. However, initiation of even an effective statin in patients with established, and especially advanced, heart failure has not improved prognosis. Statin treatment may, however, reduce complications and, importantly, has not proved to be harmful in randomized trials. Variables related to HDL metabolism are associated with heart failure in several studies, but trial evidence of HDL or triglyceride-modifying therapies is scant.


CONCLUSIONS
Whereas statins are important in preventing or postponing heart failure in the first place, their initiation in established heart failure does not improve prognosis. On the contrary, discontinuation of statin treatment is not indicated due to development of heart failure. Combination therapies of both LDL and HDL may offer more effective possibilities for heart failure prevention.
Strandberg
Timo E
TE
Institute of Health Sciences/Geriatrics, University of Oulu, Oulu University Hospital, Oulu, Finland. timo.strandberg@oulu.fi
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D008076:Cholesterol, HDL / Q000187:drug effects; D008078:Cholesterol, LDL / Q000187:drug effects*; D018450:Disease Progression; D006333:Heart Failure / Q000188:drug therapy* / Q000517:prevention & control; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy*; D017035:Pravastatin / Q000627:therapeutic use; D011322:Primary Prevention; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D014280:Triglycerides
D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D014280:Triglycerides; D000069059:Atorvastatin; D017035:Pravastatin