BMJ  2006;333:1014 (11 November), doi:10.1136/bmj.333.7576.1014-b

Practice

Short cuts

Statins are associated with a lower risk of death in people with heart failure

In a large cohort of Californians with chronic heart failure, those who started taking statins had a lower risk of death (adjusted hazard ratio 0.76 (95% CI 0.72 to 0.80)) or hospitalisation for heart failure (0.79 (0.74 to 0.85)) than those who did not. Although patients weren't randomised, the authors controlled as carefully as they could for any baseline differences between these two groups, including adjusting for age, sex, other cardiovascular drugs, presence or absence of heart disease, and each patient's propensity to get a statin. Everyone in the cohort (n=24 598) was eligible according to national guidelines.

Many of the large clinical trials of statins excluded people with heart failure, so most of the evidence for this group comes from observational studies such as this one. Although they tend to overestimate the benefit, the observational work to date has at least been consistent: patients with heart failure who take statins seem to do better than similar patients who don't. Benefits are biologically plausible: statins lower serum concentrations of low density lipoprotein cholesterol, but they may also induce angiogenesis, reduce inflammation, and stabilise coronary plaques. All of which could be useful for patients with heart failure. Two clinical trials are under way to find out.

References

JAMA 2006;296:2105-11[Abstract/Full Text]

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