No benefits of statins for sudden cardiac death prevention in patients with heart failure and reduced ejection fraction: A meta-analysis of randomized controlled trials.
OBJECTIVE
Statins showed mixed results in heart failure (HF) patients. The benefits in major HF outcomes, including all-cause mortality and sudden cardiac death (SCD), have always been discordant across systematic reviews and meta-analyses. We intended to systematically identify and appraise the available evidence that evaluated the effectiveness of statins in clinical outcomes for HF patients.


METHODS
Systematic review and meta-analysis.


METHODS
We searched, until April 28, 2016: Medline, Embase, ISI Web of Science and EBM reviews (Cochrane DSR, ACP journal club, DARE, CCTR, CMR, HTA, and NHSEED), checked clinicaltrials.gov for ongoing trials and manually searched references of included studies.


METHODS
We identified 24 randomized clinical trials that evaluated the efficacy of statins for HF patients. All randomized clinical trials were assessed for risk of bias and pooled together in a meta-analysis. Pre-specified outcomes were sudden cardiac death, all-cause mortality, and hospitalization for worsening heart failure.


RESULTS
Statins did not reduce sudden cardiac death (SCD) events in HF patients [relative risk (RR) 0.92, 95% confidence interval (CI) 0.70 to 1.21], all-cause mortality [RR 0.88, 95% CI 0.75 to 1.02] but significantly reduced hospitalization for worsening heart failure (HWHF) although modestly [RR 0.79, 95% CI 0.66 to 0.94]. Nevertheless, estimated predictive intervals were insignificant in SCD, all-cause mortality and HWHF [RR, 0.54 to 1.63, 0.64 to 1.19, and 0.54 to 1.15], respectively. An important finding was the possible presence of publication bias, small-study effects and heterogeneity of the trials conducted in HF patients.


CONCLUSIONS
Statins do not reduce sudden cardiac death, all-cause mortality, but may slightly decrease hospitalization for worsening heart failure in HF patients. The evaluation of the risk of biases suggested moderate quality of the published results. Until new evidence is available, this study supports the 2013 ACCF/AHA guidelines to not systematically prescribe statins in "only" HF patients, which should help avoid unnecessary polypharmacy.
Institute of social & preventive medicine (IUMSP) and Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Muaamar
http://orcid.org/0000-0003-1522-9812
M
Al-Gobari
Laboratoire de Biologie et Biométrie Evolutive-Service de pharmacologie clinique, Equipe Modélisation des Effets Thérapeutiques (EMET), UMR, Université Claude Bernard Lyon1, Lyon, France.
Hai-Ha
HH
Le
Laboratoire de Biologie et Biométrie Evolutive-Service de pharmacologie clinique, Equipe Modélisation des Effets Thérapeutiques (EMET), UMR, Université Claude Bernard Lyon1, Lyon, France.|Laboratoire de Pharmacologie & de Pharmacodynamie, Université Cheikh Anta Diop, Dakar, Sénégal.
Mor
M
Fall
Laboratoire de Biologie et Biométrie Evolutive-Service de pharmacologie clinique, Equipe Modélisation des Effets Thérapeutiques (EMET), UMR, Université Claude Bernard Lyon1, Lyon, France.
François
F
Gueyffier
Institute of social & preventive medicine (IUMSP) and Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Bernard
B
Burnand
D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016017:Odds Ratio; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors