Statin Therapy Group Research Articles

Statin therapy and mortality among patients hospitalized with heart failure and preserved left ventricular function - a preliminary report

Background — A number of medications such as beta-blockers, ACE-inhibitors, angiotensin receptor blockers and aldosterone antagonists, improve survival in patients with heart failure (HF) and reduced ejection fraction. No therapy has been proved to be beneficial for patients with heart failure and preserved ejection fraction (PLVEF).Objectives — The aim of the study was to assess the effect of statin therapy on all-cause mortality and cardiovascular rehospitalization rate in patients with HF and PLVEF during one-year follow-up.Methods — We evaluated 146 patients with HF and PLVEF (ejection fraction ≥ 45%). Patients were divided into the statin therapy group (n = 103, mean age 69 ± 11 y, 52 men) and the group without statins (n = 43, mean age 66 ± 16 y, 25 men).We analysed the effects of the statin treatment prescribed to patients at discharge. Patients were followed up for one year.Results — The age, gender, NYHA functional class, prevalence of co-morbidities (renal dysfunction, COPD, diabetes mellitus) did not differ between the groups (P= NS). Patients receiving statin therapy more frequently had an ischaemic aetiology of HF (79% vs. 39.5%; P < 0.001) and hypertension (76% vs. 58%; P < 0.05). No differences in ejection fraction were observed neither by echocardiography (58% vs. 55%; P= NS) nor by basic laboratory data. Patients who received statins were often additionally treated with beta-blockers (91% vs. 70%; P < 0.005), aspirin (77 vs. 44%; P < 0.01), thienopyridines (22% vs. 5%; P < 0.01) and less frequently with oral anticoagulants (5% vs. 23%; P < 0.005). In the group receiving statins a significantly lower mortality (4% vs. 21%; P < 0.001) and rehospitalization rate (43% vs. 69%; P < 0.05) was documented. After adjustment for all univariate predictors of the occurrence of study primary end-points, statin therapy was shown to be associated with significant and independent reduction in all-cause mortality (HR = 0.24 [95%CI: 0.07 – 0.90] P < 0.05) and cardiovascular rehospitalization rate (HR = 0.55 [95%CI: 0.33 – 0.92] P < 0.05). After propensity matching statin therapy remained an independent factor reducing one-year mortality rate (HR = 0.11 [95%CI: 0.01 – 0.99] P < 0.05].Conclusions — This study showed that statin therapy may have beneficial effects on mortality and rehospitalization rates among patients with HF and PLVEF. It also suggests a potential role for statins as a new therapeutic option in patients with HF and PLVEF, but these observations need to be confirmed in large randomized trials.

Pleiotropic Effects of Statins May Improve Outcomes in Atherosclerotic Renovascular Disease

Atherosclerotic renovascular disease (ARD) coexists with arterial obstructive disease in the coronary, cerebral, and peripheral arteries that may remain underdiagnosed and untreated. This retrospective study compares overall survival and renal survival (i.e., time to doubling of serum creatinine or end-stage renal disease (ESRD)) over an 11-year period in 104 ARD patients of whom 68 received statin therapy (group S) because of elevated lipid levels and 36 had no statin (group NS) because of normal lipid profile at entry. Atherosclerosis in another vascular bed was documented in 84%. Lipid profiles at end point were virtually identical in both the groups. Group S had mean survival 123months (confidence interval (CI) 113-134) with four deaths, and mean renal survival 122months (CI 113-131). Group NS had mean survival 33 months (CI 23-42) with 13 deaths, and mean renal survival 27 months (CI 17-37). Statin therapy was associated with lesser rate of progression of renal insufficiency (with 7.4% of S patients reaching renal end points vs. 38.9% of NS patients) and lower overall mortality (5.9 % in S vs. 36.1% in NS patients), P < 0.001 for both. Although both groups received what was deemed optimal therapy, they did have other differences that may have affected the outcomes (a limitation addressed by Cox multiple regression analysis). These results suggest the need for prospective randomized controlled studies in ARD patients in order to explore potential benefits of statins that may not be attributable solely to lipid lowering.

Reduced Mortality Rates after Intensive Statin Therapy in Managed-Care Patients

Objectives To evaluate whether intensive statin therapy in a managed-care setting produces greater clinical benefit than more moderate statin use. Methods Adults hospitalized for a coronary heart disease (CHD) event were identified from a longitudinal database of pharmaceutical and medical claims. Propensity scores representing a patient's likelihood of receiving statin therapy were calculated. Statin-treated patients were those who received statin therapy within 30 days of hospital discharge after a CHD event, had been supplied with statin therapy for at least 10 days during the follow-up period, and received statin therapy for at least 10 days before the first recurrent CHD event. Standard or intensive statin therapy was identified according to low-density lipoprotein cholesterol reductions expected with statin dose. Patients in the standard and intensive groups were matched by propensity scores to patients not receiving statin therapy after discharge. Patients in the standard statin therapy group were also matched to patients who received intensive statin therapy. Mortality rates after hospital discharge were compared in all matched groups. Results Patients treated with standard therapy experienced a 32% reduction in risk of death compared with patients not receiving statin therapy ( P = 0.003). Patients who received intensive statin therapy after a CHD event experienced a 42% reduction in risk of mortality ( P = 0.002) versus those not receiving statin therapy. Compared with standard therapy, intensive statin treatment further reduced the risk of death by 29% ( P = 0.020). Conclusion High risk CHD patients benefit from intensive statin therapy in a real-world, managed-care cohort, confirming the results of randomized clinical trials.

Reduced risks of death and CHF are associated with statin therapy administered acutely within the first 24 h of AMI

Background Reports have demonstrated an association between statin therapy during the first day of hospitalization for acute myocardial infarction (AMI) and reduced mortality. There are little data about whether early statin therapy reduces risk of CHF and alters timing of death. Methods We identified 3226 consecutive patients with AMI from 1993 through 2000 and divided them into early statin therapy (statins were administered within the initial 24 h of hospitalization, n = 220) and non-statin therapy groups ( n = 3006). We compared mortality risks, rates of CHF development and measures of peak CK and CK-MB values between the groups. Results In-hospital mortality was lower in the early statin therapy group (2.7%) compared to the non-statin therapy group (9.2%), p = 0.001. We observed no differences in the median time to death (statin group 132 h vs. non-statin group 72 h), p = 0.3. Patients with very early statin treatment had lower peak CK (624 ng/ml) and CK-MB (46 ng/ml) values compared to non-statin patients (848 ng/ml and 84 ng/ml), p < 0.01. Patients in the early statin group had lower risks of developing CHF during hospitalization (10.2 %) compared to the non-statin group (25.7%), p < 0.001. Conclusion Very early administration of statin therapy during the first day of hospitalization for AMI was associated with lower in-hospital mortality, lower rates of developing CHF and reduced peak biomarker release. These data support a benefit from early statin therapy in AMI and support the need for prospective studies which test whether very early statin therapy might also reduce infarct size.

Preoperative Statin Therapy Does Not Reduce Cognitive Dysfunction After Cardiopulmonary Bypass

The purpose of this study was to determine if patients receiving statin therapy before coronary artery bypass grafting surgery would have less cognitive dysfunction after cardiopulmonary bypass as a consequence of a diminished inflammatory response. Retrospective observational study of patients undergoing coronary artery bypass grafting surgery. Referral center for cardiothoracic surgery at a university hospital. Four hundred forty patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass. None. Thirty-five percent of patients received statins in the preoperative period. Multivariable analysis revealed no effect of preoperative statin therapy on cognitive function (p = 0.67). Post hoc analysis revealed that statin therapy at hospital discharge was associated with less improvement in cognitive performance at 6 weeks after surgery (p = 0.011). No significant differences were found between statin therapy groups in either range or maximum value of any of the cytokines (p > 0.05). Preoperative statin therapy did not decrease the inflammatory response to cardiopulmonary bypass or the cognitive dysfunction commonly seen after cardiac surgery.