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Statin therapy and risks for death and hospitalization in chronic heart failure
Alan S Go1, Wendy Y Lee, Jingrong Yang
1Division of Research, Kaiser Permanente of Northern California, Oakland 94612, USA. Alan.S.Go@kp.org
Insights
Initiating statin therapy in patients with heart failure significantly lowered risks of death and hospitalization. This benefit was observed in individuals with or without coronary heart disease, highlighting statins
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Epidemiology
Background:
- The role of statin therapy in improving clinical outcomes for patients diagnosed with heart failure remains uncertain.
- Existing research has not definitively established whether statins offer benefits in managing heart failure patients.
Purpose of the Study:
- To investigate the association between the initiation of statin therapy and the risks of mortality and hospitalization in adults with chronic heart failure.
- To determine if starting statin treatment impacts the likelihood of death or heart failure-related hospital admissions in this patient population.
Main Methods:
- A propensity-adjusted cohort study was conducted involving adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had no prior statin use.
- Data were collected from an integrated health care delivery system in northern California between 1996 and 2004, with statin use determined via outpatient prescription records.
- The study examined all-cause mortality and heart failure hospitalizations over a median follow-up of 2.4 years, adjusting for potential confounders and stratifying by coronary heart disease status.
Main Results:
- Among 24,598 eligible patients, 12,648 initiated statin therapy. These patients were generally younger, male, and had more comorbidities like cardiovascular disease, diabetes, and hypertension.
- Incident statin use was linked to significantly lower risks of death (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.72-0.80) and heart failure hospitalization (aHR, 0.79; 95% CI, 0.74-0.85).
- These associations persisted after adjusting for propensity scores, cholesterol levels, other cardiovascular medications, and potential confounders, and were consistent in patients with and without coronary heart disease.
Conclusions:
- In adults with heart failure and no prior statin use, initiating statin therapy was independently associated with reduced risks of death and hospitalization.
- The beneficial effects of statin initiation were evident regardless of the presence or absence of coronary heart disease, suggesting a broad protective role.
Context:
Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear.
Objective:
To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure.
Design, Setting, And Patients:
Propensity-adjusted cohort study of adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had no previous known statin use, within an integrated health care delivery system in northern California between January 1, 1996, and December 31, 2004. Statin use was estimated from filled outpatient prescriptions in pharmacy databases.
Main Outcome Measures:
All-cause death and hospitalization for heart failure during a median of 2.4 years of follow-up. We examined the independent relationships between statin therapy and risks for adverse events overall and stratified by the presence or absence of coronary heart disease after multivariable adjustment for potential confounders.
Results:
Among 24,598 adults diagnosed with heart failure who had no prior statin use, those initiating statin therapy (n = 12,648; 51.4%) were more likely to be younger, male, and have known cardiovascular disease, diabetes, and hypertension. There were 8235 patients who died. Using an intent-to-treat approach, incident statin use was associated with lower risks of death (age- and sex-adjusted rate of 14.5 per 100 person-years with statin therapy vs 25.3 per 100 person-years without statin therapy; adjusted hazard ratio, 0.76 [95% confidence interval, 0.72-0.80]) and hospitalization for heart failure (age- and sex-adjusted rate of 21.9 per 100 person-years with statin therapy vs 31.1 per 100 person-years without statin therapy; adjusted hazard ratio, 0.79 [95% confidence interval, 0.74-0.85]) even after adjustment for the propensity to take statins, cholesterol level, use of other cardiovascular medications, and other potential confounders. Incident statin use was associated with lower adjusted risks of adverse outcomes in patients with or without known coronary heart disease.
Conclusion:
Among adults diagnosed with heart failure who had no prior statin use, incident statin use was independently associated with lower risks of death and hospitalization among patients with or without coronary heart disease.
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