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In people with mild or no heart failure, statins reduce hospitalizations due to heart failure more than placebo, standard care, or lower-dose statins

Preiss D, Campbell RT, Murray HM, et al. The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials. Eur Heart J. 2015;36:1536-46.

Review question

In people with mild or no heart failure, do statins reduce hospitalizations or death due to heart failure?

Background

People who have coronary heart disease often develop heart failure. Heart failure occurs when your heart can’t pump blood quickly enough to meet the needs of your body.

Statins are drugs that lower cholesterol levels in the blood and reduce cardiovascular events such as heart attacks or strokes. Statins may also prevent heart failure.

How the review was done

The researchers did a systematic review, searching for studies that were published in English up to January 2014.

They included 17 randomized controlled trials of statins to prevent new or repeated cardiovascular disease in their analysis. The trials included 132,568 adults (average age 63 years, 71% men). Studies were excluded if everyone in the study already had heart failure, had received an organ transplant, or was having dialysis for kidney failure.

The key features of the studies were:

  • most people did not have heart failure; less than 3% had mild heart failure;
  • statins used were atorvastatin, pravastatin, simvastatin, lovastatin, and rosuvastatin;
  • statins were compared with placebo or standard care, or higher-dose statins were compared with lower-dose statins; and
  • people were followed for an average 4.3 years.

What the researchers found

Compared with placebo, standard care, or lower-dose statins, statins:

  • reduced the number of people hospitalized with nonfatal heart failure; and
  • had similar rates of death due to heart failure.

Conclusion

In people with mild or no heart failure, statins reduce first hospitalizations due to heart failure more than placebo, standard care, or lower-dose statins.

Statins vs control (placebo, standard care, or lower-dose statins) in people with mild or no heart failure

Outcomes*

Number of trials (people)

Rate of events with statins

Rate of events with control

Absolute effect of statins at an average 4.3 years

First hospitalization for nonfatal heart failure

17 trials (132,568 people)

2.0%

2.3%

About 23 fewer people out of 10,000 had a first hospitalization for heart failure (from as few as 7 to as many as 36 out of 10,000)

Death due to heart failure

14 trials (115,570 people)

0.37%

0.38%

No difference in effect†

First hospitalization for nonfatal heart failure or death due to heart failure

14 trials (115,570 people)

2.1%

2.3%

About 19 fewer people out of 10,000 had a first hospitalization for heart failure or died due to heart failure (from as few as 2 to as many as 35 out of 10,000)

*Not including heart failure–related events that happened less than 30 days after a heart attack.

†Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.



Related Topics


Glossary

Coronary heart disease
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

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