In:
Cardiology, S. Karger AG, Vol. 108, No. 1 ( 2007), p. 28-34
Abstract:
〈 i 〉 Background: 〈 /i 〉 HMG-CoA reductase inhibitors (statins) are widely prescribed in patients with established systolic chronic heart failure (CHF). However, there is considerable controversy regarding their benefit in this setting. We therefore conducted a post-hoc analysis of outcomes according to statin use within the Second Cardiac Insufficiency Bisoprolol Study of the beta-blocker, bisoprolol, in NYHA classes III–IV systolic CHF patients (left ventricular ejection fraction 〈 35%), eceiving background ACE inhibitor and diuretics. 〈 i 〉 Methods: 〈 /i 〉 Analysis of clinical outcomes was performed according to baseline use of statins and subsequent randomisation to placebo or bisoprolol. Cumulative incidence curves for clinical events were constructed using the Kaplan-Meier method and tested for significance by log-rank statistic. Multivariate analysis was performed using the Cox proportional hazards regression model. 〈 i 〉 Results: 〈 /i 〉 Two hundred and twenty-six of 2,647 patients were receiving statins at baseline (8.5%). Patients were well-matched in the 4 study groups at baseline for gender, weight, NYHA class and LVEF, however statin/bisoprolol patients were significantly younger (p 〈 0.05). Statin use at baseline was associated with a significant survival benefit compared with no statin use (p 〈 0.005, hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.39–0.94). This benefit remained after adjusting for other significant predictors of survival (p 〈 0.05, HR = 0.60, 95%CI = 0.39–0.94). A significant interaction effect was noted with bisoprolol, survival being greatest in the statin/bisoprolol group (p 〈 0.001, HR = 0.14, 95% CI = 0.03–0.60). Survival was 98.3% in the statin/bisoprolol group, 82.1% in the statin/placebo group, 87.2% in the no statin/bisoprolol group and 82.8% in the no statin/placebo group. The statin/bisoprolol group was also associated with fewer cardiovascular (p 〈 0.005) and sudden deaths (p 〈 0.0005) compared with other groups. 〈 i 〉 Conclusions: 〈 /i 〉 Despite the post-hoc, non-randomised nature of this analysis, these observations suggest that statin use appears to be beneficial in CHF. Furthermore, there appears to be a favourable interaction between statins and beta-blockade within the Second Cardiac Insufficiency Bisoprolol Study cohort. Prospective studies of statins are required to definitively address the role of these agents in established CHF.
Type of Medium:
Online Resource
ISSN:
0008-6312
,
1421-9751
Language:
English
Publisher:
S. Karger AG
Publication Date:
2007
detail.hit.zdb_id:
1482041-9
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