Benefits of statin use may
outweigh risks for patients with chronic heart failure, according to Kaiser
Permanente researchers who studied a diverse population of patients with
heart failure who were considered eligible for lipid-lowering therapy. The
study appears in the November 2006 issue of the Journal of the American
Medical Association (JAMA).
Despite its important role in preventing cardiovascular events in the
general population, the use of statins for heart failure patients has been
controversial. Past epidemiologic studies have observed a higher risk of
adverse events with the low cholesterol levels in people with heart
failure. Statins also lower levels of coenzyme Q and other proteins that
could negatively affect heart function and may lead to high levels of
toxins that can increase inflammation in those with heart failure,
according to researchers.
However, researchers in this study found that statin use was associated
with a 24 percent lower relative risk of death compared with not receiving
statins. Similarly, statin use was associated with a 21 percent lower
adjusted relative risk for hospitalization compared with not receiving
statins.
"This study, along with at least two large clinical trials already
underway, will help us better understand the effect of statins on heart
failure patients, who were largely excluded from earlier trials proving
that statins are highly effective for prevention of vascular events and
death," said lead investigator Alan S. Go, MD, with the Kaiser Permanente
Division of Research in Oakland, CA and the UCSF department of
epidemiology, biostatistics and medicine.
"However, since we saw the beneficial association of statins (for death
and hospitalization) in those with and without coronary artery disease, we
need clinical trials to look specifically at heart failure patients who
don't already have a strong indication to receive statins or other
cholesterol-lowering therapy."
Investigators identified 24,598 adults with diagnosed heart failure who
had no prior known statin use and were considered eligible for
cholesterol-lowering therapy. The data were adjusted for socio-demographic
characteristics, other illnesses, use of other therapies, and the
likelihood of receiving statins.
Additional researchers on this study include: Wendy Y. Lee, Tufts
School of Medicine, Boston, MA; Jingrong Yang, MA, Kaiser Permanente
Division of Research in Oakland, CA; Joan C. Lo, MD, with the Kaiser
Permanente Division of Research and UCSF-affiliated San Francisco General
Hospital Medical Center; and Jerry H. Gurwitz, MD, Meyers Primary Care
Institute, University of Massachusetts Medical School. The study was funded
by a research grant from Amgen, Inc.
The Kaiser Permanente Division of Research conducts, publishes, and
disseminates epidemiologic and health services research to improve the
health and medical care of Kaiser Permanente members and the society at
large. It seeks to understand the determinants of illness and well-being
and to improve the quality and cost-effectiveness of health care.
Currently, DOR's 400-plus staff is working on more than 250 epidemiological
and health services research projects.
UCSF is a leading university that consistently defines health care
worldwide by conducting advanced biomedical research, educating graduate
students in the life sciences and providing complex patient care.
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