Lipids, statins, and clinical outcomes in heart failure: rethinking the data

Lower serum lipid levels are paradoxically predictive of poor clinical outcomes in hospitalized and ambulatory patients with heart failure (HF). In large randomized controlled trials, statins did not demonstrate an overall mortality benefit in chronic HF patients. We currently lack adequate prospective data that aggressive lipid management in HF truly alters disease course and progression. Despite their traditional use as lipid-lowering agents, hypothesis-generating works have suggested that statins may show benefit in specific enriched HF subgroups. Given that patients hospitalized for HF continue to face a high post-discharge event rate and that statins are increasingly inexpensive, widely available, and generally well tolerated, it is imperative that we identify those HF patients most likely to benefit and reconsider testing these agents in specific subpopulations.