Statins for heart failure: still caught in no man's land?

Statins are well-known for their ability to lower serum cholesterol levels, but have properties beyond mere cholesterol reduction, including an improvement in endothelial dysfunction, release of endothelial progenitor cells, anti-inflammatory properties and a number of antitumour activities. In the present issue of Clinical Science, Stumpf et al. show that a 4-week treatment course with the lipophilic statin atorvastatin ameliorates left ventricular remodelling and function, reduces serum levels of TNF-alpha (tumour necrosis factor-alpha), IL (interleukin)-6 and MCP-1 (monocyte chemoattractant protein-1), and increases both serum and myocardial levels of IL-10. The authors hypothesize that this shift from a pro- to an anti-inflammatory response might be beneficial in the clinical setting, because patients with low levels of IL-10 may fare worse than those with higher levels. In light of the recent setbacks with rosuvastatin in large-scale clinical trials, this notion requires further investigation, but highlights the need to identify those patients with heart failure who are likely to benefit from statin therapy.