Statins for Heart Failure – More and Better

Implications:

• Statins produce a number of potentially beneficial actions other than lipid lowering that may be important in heart failure.
• There is now evidence suggestive of a survival benefit of statins in patients with HF.
• Clinical trials of statins in heart failure, a large unmet medical need, are apparently underway.
• It appears the pharmaceutical industry is “stepping up to the plate” to explore this major opportunity.

Kiran K. Khush, MD; David D. Waters, MD; Vera Bittner, MD; Prakash C. Deedwania, MD; John J.P. Kastelein, MD; Sandra J. Lewis, MD; Nanette K. Wenger, MD. Effect of High-Dose Atorvastatin on Hospitalizations for Heart Failure. Subgroup Analysis of the Treating to New Targets (TNT) Study. Circulation. 2007;115:576-583

http://circ.ahajournals.org/cgi/reprint/115/5/576

I have been writing in these pages about the multiple potential benefits of statins in conditions other than hyperlipidemia, including heart failure (HF). This study is a subanalysis from the 10,000 patient Treating to New Targets Study (TNT) which compared high dose, 80 mg daily, vs 10 mg daily of atorvastatin (Lipitor, Pfizer) in patients with coronary artery disease. A secondary endpoint of the study was to assess the effects of treatment on hospitalizations for HF, which are relatively common in these patients. Those results are presented in this paper. Overall, hospitalizations for HF occurred in 2.4% of the high dose group vs 3.3% in the low dose group (P=0.116). In patients with a prior history of HF, the results were even more striking, 10.6 vs 17.3%, p=0.009, in favor of the 80mg daily dose group. Blood pressure was not different between the groups and most patients did not experience any coronary events, so the mechanisms of the beneficial effects of high dose atorvastatin are probably not simply due to lipid reduction and an antithrombotic effect. As the authors point out, these results are consistent with numerous earlier reports of potential benefits of statins in HF and prior calls for proper clinical trials to study the role of statins in treating HF. Apparently, such trials are now underway.

As I have pointed out in previous articles, there is ample evidence that statins exert multiple potentially beneficial effects in HF through various mechanisms unrelated to lipid lowering. The potentially large market for HF offers a new opportunity for the statins and the results of the present study provide the first bit of evidence of a potential survival benefit of statins in HF. It appears that the manufacturers of statins have begun to develop this possible new big indication.