Prosarcopenic Effects of Statins May Limit Their Effectiveness in Patients with Heart Failure

Some studies using small doses of statins revealed significant benefits for patients with chronic heart failure (HF). However, the results of large randomized studies did not confirm these advantages. Along with the primary effect of cholesterol lowering, statins have many ancillary actions that may be relevant for body wasting. In this context, the fear of muscle-related side effects needs to be put into clinical context and assessed appropriately before statins are either withheld or withdrawn in patients with sarcopenia (muscle wasting). Some of the mechanistic bases of statin-mediated muscle dysfunction correspond with mechanisms of sarcopenia observed in HF with reduced ejection fraction patients, connected with insulin-like growth factor 1, inflammation, the ubiquitin-proteasome pathway, apoptosis, and myostatin. Here we present the hypothesis of potential prosarcopenic properties of statins as a possible explanation of the lack of effectiveness of these drugs in HF patients.