Do statins reduce the risk of myocardial infarction in patients with heart failure? A pooled individual-level reanalysis of CORONA and GISSI-HF
Open accessAbstract
Aims: Current guidelines do not explicitly recommend statin use in heart failure (HF). Relatively low numbers of atherothrombotic events among HF patients, in the context of their elevated competing risks for non-atherothrombotic causes of death, may have prevented previous analyses of clinical trials from detecting a benefit for statins. We pooled data from two landmark trials of HF patients not on statin therapy randomized to rosuvastatin 10 mg daily vs. placebo, CORONA and GISSI-HF, in order to improve our power to detect statistically significant differences in atherothrombotic events. We also accounted for competing risks from other causes of death. Methods and results: We used competing risks analyses to evaluate atherothrombotic events in the context of death from other cardiovascular and non-cardiovascular causes. We also performed traditional Cox survival analyses of the same data with the intention that these statistical approaches would be complementary. CORONA participants (n = 5011, median follow-up 32.8 months) were older and sicker than GISSI-HF participants (n = 4574, median follow-up 46.9 months) by design. Rosuvastatin decreased risk for myocardial infarction (MI) among CORONA and GISSI-HF participants with ischaemic aetiology of HF (hazard ratio 0.81, 95% confidence interval 0.66–0.99, P < 0.05). There were no significant differences between rosuvastatin and placebo in risks for stroke or death from other causes. Conclusion: This individual-level reanalysis of two landmark trials demonstrates a small but statistically significant decreased risk for MI among patients with ischaemic HF randomized to rosuvastatin vs. placebo. Rosuvastatin appears to be effective in preventing MI in ischaemic HF patients not already on statins.
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A subanalysis of FOURIER showed that patients who achieved the lowest LDL-C values under PCSK9 treatment also had the lowest risk of future MACE.
“A subanalysis of the FOURIER trial showed that patients who achieved the lowest LDL-C values under PCSK9 treatment also had the lowest risk of future MACE [451].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [451]
In a recent individual-level pooled data meta-analysis of heart failure statin trials that accounted for competing risks of mortality, there was a significant 19% reduction in MI rates among patients with ischemic etiology of heart failure.
“a recent individual-level pooled data meta-analysis of these trials, which also accounted for the competing risks of mortality, demonstrated a significant 19% reduction in MI rates among patients with ischemic etiology of heart failure (32).”
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- Authors
- Feinstein, M. J., Jhund, P., Kang, J., Ning, H., Maggioni, A., Wikstrand, J., Kjekshus, J., Tavazzi, L., McMurray, J., & Lloyd-Jones, D. M.
- Affiliations
- Northwestern University (US)
- University of Glasgow (GB)
- Associazione Nazionale Medici Cardiologi Ospedalieri (IT)
- University of Gothenburg (SE)
- Oslo University Hospital (NO)
- Maria Cecilia Hospital (IT)
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine , 680 North Lake Shore Drive, Suite 1400, Chicago, IL, 60611 ,
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-02-14
- Volume
- 17
- Issue
- 4
- Pages
- 434-441
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2172202250
- Cited by
- 56
- References
- 22
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 4 · 2019: 4 · 2018: 8 · 2017: 2 · 2016: 7 · 2015: 1
- FWCI
- 6.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- Pfizer
- AstraZeneca
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- statins, rosuvastatin, heart failure, myocardial infarction, ischemic heart failure, atherothrombotic events, competing risks, stroke, mortality, CORONA trial, GISSI-HF trial
- MeSH terms
- Rosuvastatin Calcium, Aged, Aged, 80 and over, Clinical Trials as Topic, Female, Heart Failure, Humans, Male, Middle Aged, Myocardial Infarction, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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