Cholesterol Drugs Cut Heart-Failure Deaths
Cholesterol-lowering drugs called statins can reduce deaths from advanced heart failure by as much as 55%, according to a UCLA study published today.
The increased survival occurred even though most patients who received the statins were sicker than those who did not receive them, according to the report in the Journal of the American College of Cardiology.
As many as 5 million Americans suffer from heart failure, which is characterized by the heart’s reduced ability to pump blood around the body, with half a million more diagnosed each year. It can be caused by high blood pressure, valve disease, clogged arteries and other cardiovascular problems.
Only about a third of those patients receive statins, which suggests great potential for saving lives through wider use of the drugs.
“We’re very excited about the possibilities,” said Dr. Gregg C. Fonarow of UCLA, who led the study.
The statins -- a family of drugs that includes Lipitor, Zocor, Pravachol, Crestor and Lescol -- are already among the best-selling drugs in the world. Their popularity stems from a remarkable ability to reduce the rate of heart attacks and strokes in people with a variety of risk factors, even if they do not have high cholesterol levels.
In addition to their cholesterol-lowering properties, the drugs have been shown to reduce inflammation, which plays a role in heart failure; protect against dilation of the heart’s ventricles, which reduces pumping ability; and decrease over-activity of the sympathetic nervous system, which produces too much heart-damaging adrenaline.
But statins had not previously been tested on heart-failure patients, Fonarow said. Researchers shied away from such studies, in part, because the patients were usually already taking a variety of drugs, and researchers preferred to study new medications in patients who were taking few drugs, so that the results would be more clear-cut.
There also had been studies, conducted by Fonarow, that suggested lowering cholesterol levels could harm people with heart failure.
To explore these issues, Fonarow and his colleagues took advantage of the fact that some physicians were already prescribing statins to heart-failure patients in addition to other drugs.
The team studied the records of 551 patients who received treatment for heart failure at the Ahmanson-UCLA Cardiomyopathy Center. About 45% of the patients suffered from ischemic heart failure caused by a heart attack, while the rest suffered from nonischemic heart failure, caused by high blood pressure and other problems.
Among the patients with ischemic heart failure, 73% were receiving statins, compared with 22% of those with nonischemic disease.
Among the ischemic patients, 80% of those receiving statins survived for one year without needing a heart transplant, compared with 57% of those not receiving the drugs. Among nonischemic patients, 90% of those receiving statins survived for a year, compared with 71% of those not receiving the drugs.
“Our results were dramatic,” Fonarow said. “We were surprised by the magnitude of the additional benefits of statins in patients who were already on standard medications to treat heart failure.”
The results need to be confirmed in a clinical trial in which patients are randomly selected to determine who receives the drugs, said Dr. Tamara B. Horwich of UCLA, who was a member of the team along with Dr. W. Robb MacLellan. One such trial is already underway in Italy with more than 4,000 patients. Results are expected in a year or two.
If the UCLA results are confirmed by the trial, “this should become the standard of care [for heart-failure patients], irrespective of what their baseline cholesterol is,” Fonarow said.
The study was funded by the Ahmanson-UCLA center, but Fonarow has been a paid consultant to companies that manufacture statins.
