Association of statin use and clinical outcomes in heart failure patients: A systematic review and meta-analysis
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Abstract Background The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins’ prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF. Methods We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization. Results Finally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72–0.83, P < 0.0001, I2 = 63%), CV mortality (HR 0.82, 95% CI: 0.76–0.88, P < 0.0001, I2 = 63%), and CV hospitalization (HR 0.78, 95% CI: 0.69–0.89, P = 0.0003, I2 = 36%). All-cause mortality was reduced on statin therapy in HF with both EF < 40% and ≥ 40% (HR: 0.77, 95% Cl: 0.68–0.86, P < 0.00001, and HR 0.75, 95% CI: 0.69–0.82, P < 0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79–0.93, P = 0.0003, and HR 0.83, 95% CI: 0.77–0.90, P < 0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64–0.99, P = 0.04 and HR 0.76 95% CI: 0.61–0.93, P = 0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies’ analyses; the effect was also larger and significant for lipophilic than hydrophilic statins. Conclusions In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.
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Statins reduce HFpEF morbidity and mortality, and this benefit might depend in part on EAT and systemic inflammation reduction, not on the effect on diabetes.
“Several studies support a reduction of HFpEF morbidity and mortality induced by statins, a benefit that might depend in part on EAT and systemic inflammation reduction, and not on the effect on diabetes [148,149].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [149]
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Heart Failure Risk Reduction: Hydrophilic or Lipophilic Statins?
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Inflammation in Heart Failure: Mechanisms and Therapeutic Strategies
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Correlation between Statin Solubility and Mortality in Patients on Chronic Hemodialysis
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Heart Failure Treatment in 2023: Is There a Place for Lipid Lowering Therapy?
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Prognostic Impact of Statins in Heart Failure with Preserved Ejection Fraction
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Advances in detection, prevention and treatment of heart failure in type 2 diabetes: part I
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- Authors
- Bielecka-Dabrowa, A., Bytyçi, I., Von Haehling, S., Anker, S., Jozwiak, J., Rysz, J., Hernandez, A. V., Bajraktari, G., Mikhalidis, D. P., & Banach, M.
- Affiliations
- Medical University of Lodz (PL)
- University Clinical Center of Kosovo (XK)
- Charité – Universitätsmedizin Berlin (DE)
- University of Opole (PL)
- The Royal Free Hospital (GB)
- Corresponding author
- Banach, Maciej
- ORCID
- Venue
- Lipids in Health and Disease
- Published
- 2019-10-31
- Volume
- 18
- Issue
- 1
- Pages
- 188-188
- ISSN
- 1476-511X (ISSN-L)
- PMC
- PMC6822388
- OpenAlex
- W2989190856
- Cited by
- 57
- References
- 63
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 12 · 2023: 10 · 2022: 9 · 2021: 7 · 2020: 5
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-09-20)
- Open access
- gold
- doi.org
- Locations
- Lipids in Health and Disease (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-sa)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- statins, heart failure, left ventricular ejection fraction, all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, non-ischemic heart failure, statin therapy, clinical outcomes, sarcopenia, statin-induced liver injury, statin-induced diabetes
- MeSH terms
- Heart Failure, Humans, Prospective Studies, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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