Archief Roodbont

NEW YORK (Reuters Health) Sep 21 - The impact of statin therapy on mortality in patients with decompensated heart failure is limited to those who have ischemic heart disease, say researchers from Israel.

Dr. Roman Nevzorov and colleagues from Ben-Gurion University of the Negev in Beer-Sheva analyzed 1-year mortality rates in 887 patients hospitalized for acute decompensated heart failure.

According to the researchers' report in the European Journal of Internal Medicine for September, their cohort included 656 (74%) patients with ischemic heart disease and 231 without. Overall, 281 patients (31.7%) had been treated with statins in the 3 months preceding admission.

One-year mortality reached 21% in the patients who were treated with statins and 31.8% in the no-statins group, the authors report.

Differences in rates of fatal events were significant among patients with ischemic heart disease (20.1% in the statin group versus 30.6% in the no-statin group, p=0.006), but not among patients with non-ischemic heart disease (25.6% with statin treatment versus 34.6% without, p=0.24).

Statin therapy and implantable cardioverter-defibrillator placement were independent predictors of improved survival in a multivariate analysis of patients with ischemic heart failure. In patients with non-ischemic heart failure, the only predictors of 1-year mortality were hyponatremia, hypoalbuminemia, and Charlson's comorbidity index.

"The clinical question is whether a statin should be prescribed to every patient with heart failure," the investigators say. "Based on the recent randomized trials and results of our analysis the answer is probably no in the case of heart failure of non-ischemic origin."

"On the other hand," the researchers say, patients with active coronary artery disease and heart failure should receive statins as "secondary and tertiary prevention" unless they have contraindications.

Eur J Intern Med 2009;20:494-498.