Statins reduce hospitalisations in patients with heart failure
We are all familiar with the robust evidence base for statin therapy in CHD and it has been suggested that these drugs may have additional benefits in patients with heart failure. The Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA) study has found that rosuvastatin reduces the number of hospitalisations from cardiovascular causes in these patients.
The study included 5,011 patients, with a mean age of 73. All participants had chronic New York Heart Association class II-IV heart failure with a left ventricular ejection fraction of <40%. Patients were randomised to rosuvastatin 10mg od or placebo.
Follow-up was for a median of 33 months. The primary composite outcome was cardiovascular death, non-fatal MI or non-fatal stroke.
The study found no significant difference in the primary outcome between the two groups: 692 patients on rosuvastatin compared with 732 on placebo (hazard ratio 0.92; 95% CI 0.83-1.02, P= 0.12).
There was also no significant difference in all-cause mortality (hazard ratio 0.95; 95% CI 0.86-1.05, P= 0.31) or in other secondary outcomes, such as any coronary event occurring.
However, there were significantly fewer hospitalisations from cardiovascular causes and heart failure in patients on rosuvastatin compared with placebo.
The primary cause of death in patients with heart failure is most likely to be an arrhythmic rather than atherothrombotic event. It is therefore unsuprising that statins failed to exert an influence in this situation.
From a practical viewpoint, most patients with heart failure will already be on statins for secondary prevention of underlying coronary disease and it would be unwise to discontinue this therapy. However, I am not sure that
I would recommend starting statins for the first time in patients with heart failure.
Kjekshus J, Apetrei E, Barrios V et al. Rosuvastatin in Older Patients with Systolic Heart Failure. N Engl J Med 2007;357:2248-61Reviewer
Dr Peter Savill
GPwSI Cardiology, Southampton