title: The effect of statins on mortality in heart failure with preserved ejection fraction: a meta-analysis of propensity score analyses.
abstract: BACKGROUND
  Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. However, no pharmacological therapy has been shown to improve survival in HFpEF patients. Previous retrospective and prospective observational studies have examined the prognostic impact of hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) in patients with HFpEF. However, the results are inconsistent due to limited power with small sample sizes and/or lack of adjustment for known prognostic factors and differences in baseline characteristics between patients treated with and without statins.
  
  
  METHODS
  We aimed to conduct a meta-analysis of prospective observational studies examining the effect of statin therapy on mortality in HFpEF patients with the use of propensity score analysis.
  
  
  RESULTS
  A total of 4 studies with 5,536 patients (2,768 patients [50%] on statins; mean age, 65-77 years; male, 43-66%; coronary artery disease, 42-64%; hypertension, 61-82%; diabetes, 20-29%; follow-up duration, 12-36 months) were included in this meta-analysis. The pooled analysis showed that statin therapy was associated with reduced mortality (odds ratio [95% CI] = 0.690 [0.493-0.965], P=0.030).
  
  
  CONCLUSIONS
  Our meta-analysis suggests the potential mortality benefit of statins in HFpEF. Further prospective observational studies and randomized controlled trials should be planned to confirm our observed potential survival benefit of statins in HFpEF.
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: fukuta-h@med.nagoya-cu.ac.jp.
authors.forename: Hidekatsu
authors.initials: H
authors.lastname: Fukuta
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Wakami
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohte
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D064887:Observational Studies as Topic; D057216:Propensity Score; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D016277:Ventricular Function, Left
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: heart failure with preserved ejection fraction; meta-analysis; propensity score analysis; statins