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Statins May Markedly Improve Survival of Heart-Failure Patients

LOS ANGELES -- February 18, 2004 -- A new UCLA study shows the first evidence that patients with heart failure may benefit from statin drug treatment. The findings may lead to a novel treatment for the 5 million Americans who suffer from this life-threatening condition.

The new study, published in the Feb. 18 issue of the Journal of the American College of Cardiology, demonstrated that statin usage reduced the mortality rate of heart-failure patients by 55 percent. Heart-failure patients benefited irrespective of the cause of their heart failure and their blood cholesterol levels. The study suggests that statin usage may provide broad benefits to heart-failure patients.

This is the first study of its kind. UCLA researchers analyzed medical records of heart‑failure patients and compared mortality outcomes based on whether patients received statin treatment or not. Currently only one-third of heart-failure patients receive statins, which typically are used to lower cholesterol and inhibit artery plaque development.

"Our results were dramatic," said Dr. Gregg Fonarow, principal investigator and Eliot Corday Chair in Cardiovascular Medicine and Science; professor of medicine, UCLA division of cardiology; and director, Ahmanson-UCLA Cardiomyopathy Center. "We were surprised by the magnitude of the additional benefits of statins in patients who were already on standard medications to treat heart failure."

According to Fonarow, no clinical trial data and very little research currently exist addressing the impact of cholesterol-lowering medications on heart-failure patients. Fonarow points out that some studies have suggested both potentially negative and positive effects of statins on this patient population, which convinced Fonarow and his team to launch a more comprehensive comparative study.

UCLA investigators reviewed medical records of 551 patients at the Ahmanson-UCLA Cardiomyopathy Center, one of the nation's largest heart-failure programs. Both ischemic patients (those with heart failure due to a heart attack) and non-ischemic patients (those with heart failure due to another cause such as hypertension or diabetes) were included in the study.

Investigators found an overall 55 percent reduction in mortality rate for heart-failure patients taking a statin at a one-year follow-up compared to patients not taking a statin drug. Non-ischemic patients taking a statin saw a 73 percent mortality reduction and ischemic patients saw a 65 percent reduction. The results were independent of cholesterol levels, age, gender, medications and other factors such as diabetes or coronary artery disease.

"If randomized clinical trials mirror our results, we may have a novel treatment for heart‑failure patients," said Dr. Tamara Horwich, first author and UCLA cardiology fellow. "The next step is to further study and understand the mechanisms by which statins may be improving survival in patients with heart failure."

Fonarow notes that statins may prove to benefit heart-failure patients in several areas, including reducing inflammation that plays a role in heart failure; offering protective properties to help block dilation of the heart ventricles, which progresses in heart failure; and decreasing over-activity of the sympathetic nervous system that occurs in heart failure, which results in too much adrenaline that can harm the heart.

According to Fonarow, the UCLA study also indicates the benefits of statins may outweigh any negative impact of these drugs that some previous studies have suggested, such as lowering cholesterol too far and reducing coenzyme Q10 levels, which in heart-failure patients may be harmful.

Heart failure or cardiomyopathy occurs when the heart muscle has been damaged or weakened as a result of cardiac conditions such as long-term high blood pressure, coronary artery disease or a prior heart attack. The left ventricle becomes enlarged and the heart has to work much harder to pump blood to the rest of the body.

Each year, 500,000 new heart-failure patients are diagnosed in the United States and the economic burden of meeting the needs of this growing population is tremendous; the United States annually spends more on the medical care of heart-failure patients than all cancers combined. The number of heart-failure patients is growing due to advances in treatments that are helping people to live longer.

The study was funded by the Ahmanson-UCLA Cardiomyopathy Center.

Dr. W. Robb MacLellan, UCLA associate professor of medicine, division of cardiology, is also an author of the study.

Source: Ahmanson-UCLA Cardiomyopathy Center

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