60) with symptomatic HF attributed to
CAD and left ventricular systolic dysfunction (mean LV ejection fraction, 31%)
to receive either rosuvastatin (10 mg/day) or placebo. Median follow-up was 33
months.
In a randomized trial, rosuvastatin was associated with a decrease in hospitalizations for cardiovascular events but no reduction in mortality.
Clinical trials have shown statins’ benefits in
patients with established coronary artery disease, but individuals with heart
failure (HF) have typically been excluded from these trials. Investigators in
this manufacturer-sponsored trial randomized 5011 patients (age 60) with symptomatic HF attributed to
CAD and left ventricular systolic dysfunction (mean LV ejection fraction, 31%)
to receive either rosuvastatin (10 mg/day) or placebo. Median follow-up was 33
months.
Patients in the rosuvastatin group — but not those in the placebo group — had substantially reduced LDL-cholesterol and high-sensitivity C-reactive protein levels. However, the rate of the primary composite endpoint of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke did not differ significantly between the two groups. Patients in the rosuvastatin group had a lower risk for hospitalization for cardiovascular causes (hazard ratio, 0.92; P=0.04) and fewer hospitalizations for HF than those in the placebo group. Adverse events, including muscular symptoms, were no more frequent in the rosuvastatin group than in the placebo group.
Comment: Although rosuvastatin did not significantly reduce the combined risk for cardiovascular death, MI, or stroke in older patients with ischemic systolic heart failure, it did result in fewer hospitalizations. Therefore, these findings should not dissuade practitioners from prescribing statins in eligible patients
with HF and ischemic systolic dysfunction. However, several questions remain: Are statins generally less beneficial in patients with HF than in those without HF? Do statins’ effects lessen with age and multiple coexisting illnesses? How do rosuvastatin’s effects on health outcomes compare with those of other statins? Pending results of the GISSI-HF trial (a large, randomized, 2 x 2 factorial study of omega-3 fatty acid and rosuvastatin as adjuncts to standard HF therapy) may help to answer some of these questions.
— Frederick A. Masoudi, MD, MSPH
Published in Journal Watch General Medicine November 29, 2007
Kjekshus J et al. Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007 Nov 29; 357:2248.