The first article in our new 'Statin Series' will address the use of the therapy among patients with heart failure, the efficacy and safety assessment via three major studies- Corona, GISSI-HF and TOPCAT, and selection of the type of statin that will offer the best clinical outcome.

The usefulness and efficiency of statins are undeniable. In patients with medium, moderate, and high cardiovascular risk, they decrease mortality and cardiovascular events. Nonetheless, multiple users experience muscle complaints that add to treatment interruption. This is seen as an obstacle to preserving long-term statin adhesion. While the risk of myopathy identified in randomized clinical trials is about 1-4 per 10,000 patients over five years, the real-life occurrence of statin-associated muscle symptoms is far higher, approaching 10-20%. To alleviate statin intolerance, it is generally advised to change the statin form and dose after a brief washout time. However, a safer approach to reduce side effects and boost adherence could be to use statins carefully in different clinical scenarios.

Do statins in patients with a decreased ejection fraction reduce complicated outcomes?

Two important trials- Corona and GISSI-HF showed that LDLc was lowered by 45% and there was no difference in mortality or the primary outcome between groups. However, both the probability of multiple HF admissions and the average number of admissions tended to gain from rosuvastatin in the sub-group study of the CORONA trial. There are also reasonably reliable data that statins might not be effective in patients with HF with a decreased ejection fraction. However, there is also evidence that statins may decrease the function of the cardiac sympathetic nerve and prevent cardiac remodeling in HF patients.

Do statins decrease cardiovascular complications in preserved EF (HFpEF) patients?

In patients with HFpEF, the cardiovascular effects of statins tend to be more encouraging than those of HFrEF. In the population undergoing statin treatment, all-cause mortality was slightly lower in the TOPCAT study compared to the non-statin group (HR 0.79, 95% CI 0.63- 0.99, p = 0.04), an outcome that was independent of the occurrence of ischaemic heart disease. Although statins in HFpEF tend to be promising, the data is tentative and should be validated in randomised trials.

Is it safe for patients with heart failure to use statins?

Major HF statin assessment studies reassure that statins are effective in this population, even in the most serious patients, have comparable safety profiles in treatment or placebo categories. Clinicians can be highly vigilant to potential drug-to-drug reactions because HF patients have a diverse therapeutic regimen and polypharmacy.

In HF, is the type of statin significant?

In patients with HF, variations between hydrophilic and lipophilic statins can be significant in selecting a statin. Although hydrophilic statins (pravastatin and rosuvastatin) are generally hepato-selective, lipophilic statins (atorvastatin, simvastatin, fluvastatin, pitavastatin, and lovastatin) appear to be less selective in the liver and have greater exposure in extra-hepatic tissues. In HFrEF, statins tend to have little or no benefit but can increase certain health benefits, including all-cause mortality, in HFpEF patients.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Monish S Raut is a Consultant in Cardiothoracic Vascular Anaesthesiology. His area of expertise is perioperative management and echocardiography with numerous publications in various national and international indexed journals.