Current guidelines do not explicitly recommend statin use in heart failure ( HF ). Relatively low numbers of atherothrombotic events among patients with heart failure, 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.
Researchers pooled data from two landmark trials of patients with heart failure not on statin therapy randomized to Rosuvastatin ( Crestor ) 10 mg daily versus placebo, CORONA and GISSI-HF, in order to improve the power to detect statistically significant differences in atherothrombotic events.
Researchers also accounted for competing risks from other causes of death.
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 heart failure ( hazard ratio, HR=0.81, 95% confidence interval 0.66-0.99, P less than 0.05 ).
There were no significant differences between Rosuvastatin and placebo in risks for stroke or death from other causes.
In conclusion, this individual-level reanalysis of two landmark trials has demonstrated a small but statistically significant decreased risk for myocardial infarction among patients with ischaemic heart failure randomized to Rosuvastatin versus placebo. Rosuvastatin appears to be effective in preventing myocardial infarction in patients with ischaemic heart failure not already on statins. ( Xagena )
Feinstein MJ et al, Eur J Heart Fail 2015; Epub ahead of print