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Statins Cut Deaths From Heart Failure

Drugs reduce mortality regardless of cholesterol levels

TUESDAY, Feb. 17, 2004 (HealthDayNews) -- Widely used cholesterol-lowering drugs called statins may also benefit people with heart failure, new research shows.

A study appearing in the Feb. 18 issue of the Journal of the American College of Cardiology found statins reduced the mortality rate in patients with heart failure by 55 percent.

About 5 million Americans suffer from heart failure, which occurs when the heart muscle has been damaged or weakened as a result of conditions such as long-term blood pressure, coronary artery disease or a previous heart attack. This weakened condition makes it hard for the heart to pump enough blood to other areas of the body.

"Heart failure traditionally has a very high mortality rate," says lead investigator Dr. Gregg Fonarow, Eliot Corday chair of cardiovascular medicine and science at the University of California at Los Angeles.

Although three classes of medications have been shown to help lower the risk of mortality, the risk remains high and experts are continually looking for new treatments, Fonarow adds.

Statins are already known to reduce death rates in people who have coronary artery disease, but their effect on heart failure has not been known.

In the first study of its kind, Fonarow and his colleagues reviewed the medical records of 551 patients who had either ischemic heart failure (due to a heart attack) or non-ischemic heart failure (due to hypertension, diabetes or other causes).

Overall, patients taking statins had a 55 percent reduction in their death risk at one year compared to patients not taking statins. This was true regardless of cholesterol levels, age, gender, medications and other conditions such as diabetes.

Because mortality was independent of cholesterol levels, statins may work by a different mechanism in heart failure patients.

"[The study] points out that there are mechanisms of these drugs acting that we probably weren't aware of, and I think that is really exciting," says Dr. Edgar Lichstein, chairman of medicine at Maimonides Medical Center in New York City. "That is what advances the science. If we know what the mechanisms are, it leads to newer drugs and newer therapies."

"We've known that statins save lives, but we suspected that it was more than lowering cholesterol, and this study proves it very nicely," he adds.

It's not clear exactly what those mechanisms are, but there are several possibilities.

"Statins decrease the overactivation of the sympathetic system, which plays a major role in the risk of heart failure," Fonarow says.

Also, he adds, statins may help "remodel" the weakened heart muscle and reduce inflammation. "We recently have recognized that inflammation may play a role in the progression of heart failure," he says.

Because this is an observational study, the results need to be verified with further studies. A randomized trial is in progress now, Fonarow says.

Nevertheless, statins are already approved and widely used, so doctors could consider their use in heart failure patients right away. "The downside is minimal, if any," Lichstein says.

"We would certainly recommend that patients with heart failure be considered for statin treatment, and that's something that can be put into clinical practice," Fonarow adds.

The finding comes at the same time as another, appearing in the Feb. 17 issue of Circulation, that a four-drug regimen that includes statins reduces the risk of mortality in heart attack and unstable angina patients.

More information

For more on heart failure, visit the National Heart, Lung, and Blood Institute or the American Heart Association.

SOURCES: Gregg Fonarow, M.D., Eliot Corday chair, cardiovascular medicine and science, and professor, medicine, University of California, Los Angeles; Edgar Lichstein M.D., chairman, medicine, Maimonides Medical Center, New York City; Feb. 18, 2004, Journal of the American College of Cardiology
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