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.

For more information on Kaiser Permanente Research, go to: blog.kaiser-permanente/research/

The Kaiser Permanente Division of Research

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