Favorable effects of statins in the treatment of heart failure with preserved ejection fraction in patients without ischemic heart disease.

BACKGROUND: The effects of statins in patients with heart failure with preserved ejection fraction (HFpEF) remain unclear. This study aimed to assess whether statin therapy is associated with a decreased risk of mortality in patients with HFpEF.

METHODS: We used data from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. The primary outcome was all-cause mortality. We analyzed hazard ratios (HRs) for outcomes with 95% confidence intervals (95% CIs) in patients taking statins compared with those not taking statins using multivariable Cox proportional hazard models.

RESULTS: This study included 3378 patients with HFpEF. The mean follow-up period was 3.3years; 497 patients died during the study period. Among all patients, the adjusted HR for all-cause death was significantly lower in those taking statins compared with those not taking statins (HR 0.79, 95% CI 0.63-0.99, P=0.04). The risks of all-cause and cardiovascular mortality in patients without ischemic heart disease (IHD) were significantly lower in those taking statins compared with those not taking statins (HR 0.63, 95% CI 0.44-0.91, P=0.01 and HR 0.59, 95% CI 0.37-0.94, P=0.02, respectively), whereas the risks in patients with IHD did not differ significantly between those taking and not taking statins (HR 0.97, 95% CI 0.72-1.31, P=0.83 and HR 0.95, 95% CI 0.66-1.36, P=0.77, respectively). Among propensity score-matched patients without IHD, the risks of all-cause and cardiovascular death were significantly lower in those taking statins compared with those not taking statins.

CONCLUSIONS: Statin therapy was associated with improved outcomes in HFpEF patients, particularly those without IHD.