Statins for Congestive Heart Failure Patients

It might sound paradoxical, but low cholesterol levels have been associated with higher morality levels in patients with congestive heart failure – this has been shown in analysis of thousands of patients. Whether low cholesterol helps cause problems or is a marker of more severe debilitation (e.g. cachexia, liver problems, and inadequate nutrition), is not known. This has led to some trepidation in using statins for heart failure patients.

Doctors frequently prescribe statins as part of a treatment regimen for people with heart failure. Because statins stabilize plaque on blood vessel walls, they can reduce the risk of “acute coronary syndrome” (though people with congestive heart failure tend to have low rates of this syndrome). Statins can also reduce the reduce inflammation of the blood vessels and inhibit arrhythmia.

There are concerns that statin use may result in increased risk of infection. Serum cholesterol is thought to aid in removal of bacteria from the blood vessels, and the muscle-harming effects of statins affect the heart muscle as well as skeletal muscles.

Congestive heart failure is classified as Systolic heart failure or Diastolic heart failure. In systolic heart failure there is insufficient (less than half normal) pumping action. In diastolic heart failure, the muscles are less able to relax when they should.

Statin use in systolic heart failure has been examined in large randomized trials published in 2007 and 2008. These were referred to as the CORONA trial and the GISSI-HF trial. Neither study showed benefit of statins. The evidence related to diastolic heart failure is less solid, but statins seem to have benefit to these patients. The OPTIMAAL study found that a combination of beta blockers and statins given to patients directly after myocaridal infarction had lower mortality.