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Statin Use and Survival Outcomes in Elderly Patients With Heart Failure
Joel G. Ray, MD, MSc;
Yanyan Gong, MSc;
Kathy Sykora, MSc;
Jack V. Tu, MD, PhD
Arch Intern Med. 2005;165:62-67.
Background Coronary artery disease is a leading cause of heart failure. Statins are efficacious drugs for the primary and secondary prevention of coronary heart disease, but their value in persons with heart failure remains unknown.
Methods We performed a population-based retrospective cohort study involving the entire province of Ontario, Canada, restricting participants to those aged 66 to 85 years who were free of cancer and who survived at least 90 days following hospitalization for newly diagnosed heart failure. The primary study outcome was the risk of death from all causes, nonfatal acute myocardial infarction, or nonfatal stroke among persons newly dispensed statins (n = 1146) relative to those who were not (n = 27 682).
Results The mean age of all participants was 76.5 years, and half were women. During the 7-year study period, death, acute myocardial infarction, or stroke occurred in 217 statin recipients (13.6 per 100 person-years) vs 12 299 nonrecipients (21.8 per 100 person-years; adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.63-0.83). Most of the benefit from statins was related to a reduction in all-cause mortality (adjusted HR, 0.67; 95% CI, 0.57-0.78). No significant reduction was seen for subsequent myocardial infarction (adjusted HR, 0.81; 95% CI, 0.63-1.03) or stroke (adjusted HR, 0.81; 95% CI, 0.53-1.25).
Conclusions Statin use is associated with a lower risk of death among seniors newly diagnosed as having congestive heart failure. While statin use has been previously shown to be efficacious in patients with coronary heart disease and stroke, we could not control for all prognostic risk factors in the present study, including left ventricular ejection fraction and serum lipid levels. Better evidence can direct clinicians about which patients with heart failure might benefit from these drugs.
Author Affiliations: Department of Medicine, St Michael’s Hospital, University of Toronto (Dr Ray); Programming and Biostatistics & Canadian Cardiovascular Outcome Research Team, Institute for Clinical Evaluative Sciences (Ms Gong); Canadian Cardiovascular Outcome Research Team, Institute for Clinical Evaluative Sciences (Ms Sykora); and Institute for Clinical Evaluative Science, Department of Medicine, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto (Dr Tu), Toronto, Ontario.
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