Statin therapy modifies the prognostic value of immune-inflammatory indices in acute HFpEF: Data from the LECRA-HF...

The pathophysiology of heart failure with preserved ejection fraction (HFpEF) isassociated with inflammation; however, this knowledge has yet to be utilized in clinical practice.

We conducted a retrospective study to evaluate the association between statin therapy,levels of immune-inflammatory biomarkers (IIBs), and 5-year all-cause mortality among patientswith HFpEF in the Polish population.

We analyzed 311 HFpEF patients hospitalized between 2009 and 2019 and includedin the LECRA-HF Registry. IIBs (neutrophil-to-lymphocyte ratio [NLR], derived NLR [dNLR], lymphocyte-to-monocyte ratio [LMR], systemic immune-inflammation index [SII], and pan-immune-inflammation value [PIV]) were calculated and patients were stratified according to statin therapyat discharge. All-cause mortality was analyzed over a median follow-up of 52 months.

Two hundred three patients (65%, median age 77 years, 59.6% females) were receivingstatin therapy, while 108 patients (35%, median age 75 years, 56.5% females) were not prescribedstatins. Elevated SII without statins was associated with the lowest survival, whereas high LMR andlow PIV among statin users conferred the best outcomes. LMR was associated with reduced mortalityin HFpEF patients not receiving statins (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.26-0.82).NLR (OR, 1.51; 95% CI, 1.03-2.22; P = 0.034), dNLR (OR, 1.92; 95% CI, 1.07-3.45; P = 0.029), SII (OR, 2.09;95% CI, 1.19-3.67; P = 0.010) and PIV (OR, 2.32; 95% CI, 1.13-4.78; P = 0.023) independently predictedmortality in the non-statin group, with interactions observed between statin therapy and dNLR(P for interaction = 0.042) and PIV (P for interaction = 0.036).

The IIBs, particularly dNLR and PIV, were independent predictors of mortality instatin-naive HFpEF patients, whereas their prognostic associations differed according to statinprescription status.