Statin therapy modestly lowers the risk of heart failure hospitalisation

Preiss D, Campbell RT, Murray HM, et al.
Eur Heart J 2015 36: 1536-1546

Background

The most common cause of heart failure (HF) is reported to be coronary heart disease (CHD) [1]. Since statin therapy lowers the risk of myocardial infarction (MI) in primary and secondary prevention populations [2], it should also reduce the development of HF. Statin therapy may also influence the development of HF via other mechanisms.
Studies have looked into the relationship between statin therapy and HF outcomes, but the type of HF endpoints used have varied. This heterogeneity in the categories of HF outcomes impeded comprehensive pooling and analysis of HF data.
The current analysis aimed to obtain comprehensive and harmonised data for major HF events (non-fatal hospitalisation, death, and a composite of both) in major statin trials. Thereby this study evaluates whether statin therapy reduces major HF events, and if so, if this was primarily driven by a reduction in non-fatal MI. Unpublished data of up to 132568 participants from 17 trials were included in the main analysis, with follow-up data for a mean of 4.3 years. Average age of the participants was 63 years, 29% of them were female.

Main results

• In the 16 trials who provided data on non-fatal MI, this event was reduced by 26% with statin therapy (2287 first events in 65438 participants on statins vs. 3107 in 65530 on control: RR: 0.74, 95%CI: 0.70-0.78).
• Based on 17 trials, statins reduced first non-fatal HF hospitalisation by 10% (RR: 0.90, 95%CI: 0.84-0.97), with numbers needed to treat (NNT) of 1454 (non-significant: NS) in the primary prevention trials, 552 (NS) in mixed trials and 200 in secondary-prevention trials over 5 years.
• HF death was unaffected by statin therapy (RR: 0.97, 95%CI: 0.80-1.17).
• The composite HF outcome was reduced by 8% with statin therapy, based on 14 trials (RR: 0.92, 0.85-0.99).
• Only 10-15% of first composite HF outcomes and non-fatal HF hospitalisations were preceded by a documented non-fatal MI (not including HF events within 30 days of MI). Statin therapy did not affect the risk of a first HF event, whether or not it was preceded by a within-trial MI.

Conclusion

This analysis shows that statin therapy led to a lower number of participants with HF events in major primary and secondary prevention trials, with about 4 years of follow-up. The risk of the composite of non-fatal hospitalisation and HF death was reduced by ~10%, mostly driven by a reduction in non-fatal hospitalisations.
The benefit of statins for HF outcomes did not appear to depend on whether patients previously experienced an MI. The vast majority of participants experiencing an HF event did not have a preceding within-trial MI.

Find this article online at Eur Heart J

References

1. Rich MW. Epidemiology, pathophysiology, and etiology of congestive heart failure in older adults. J Am Geriatr Soc 1997;45:968–974.
2. Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670–1681.