Randomized clinical outcome trials of statins in heart failure

Morbidity and mortality in patients who have heart failure (HF) remains substantial, and new therapies are needed. Tantalizing evidence from experimental studies, retrospective analyses, and limited prospective clinical investigations have suggested that statin therapy may improve ventricular function, HF status, and clinical outcomes independently of HF etiology and through mechanisms other than statin effects on dyslipidemia. The Controlled Rosuvastatin in Multinational Trial in Heart Failure (CORONA) is the first prospective randomized clinical outcome trial with statins focused specifically on HF. Over a median follow-up of 33 months, there were no significant differences in the primary end point or in all-cause mortality, the rate of coronary events, effects on New York Heart Association class, or the rate of newly diagnosed diabetes. There were significant reductions in the number of cardiovascular hospitalizations and, in a post hoc analysis, in nonfatal ischemic events. The discrepancy between the results from previous observational studies and the results of the CORONA trial emphasizes the importance of prospective randomized clinical outcome trials.